Aging Male Symptoms Research Articles

1236 EFFECTS OF LONG-TERM ANDROGEN REPLACEMENT THERAPY ON PHYSICAL AND MENTAL STATUS IN AGING MALES WITH LATE-ONSET HYPOGONADISM: RESULTS OF A PHASE III, MULTICENTER, RANDOMIZED, CONTROLLED TRIAL

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Evaluation (I)1 Apr 20131236 EFFECTS OF LONG-TERM ANDROGEN REPLACEMENT THERAPY ON PHYSICAL AND MENTAL STATUS IN AGING MALES WITH LATE-ONSET HYPOGONADISM: RESULTS OF A PHASE III, MULTICENTER, RANDOMIZED, CONTROLLED TRIAL Hiroyuki Konaka, Kazuhiro Sugimoto, Kazuyoshi Sigehara, Yoshifumi Kadono, Eitetsu Koh, and Mikio Namiki Hiroyuki KonakaHiroyuki Konaka Kanazawa, Japan More articles by this author , Kazuhiro SugimotoKazuhiro Sugimoto Kanazawa, Japan More articles by this author , Kazuyoshi SigeharaKazuyoshi Sigehara Kanazawa, Japan More articles by this author , Yoshifumi KadonoYoshifumi Kadono Kanazawa, Japan More articles by this author , Eitetsu KohEitetsu Koh Kanazawa, Japan More articles by this author , and Mikio NamikiMikio Namiki Kanazawa, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2590AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although several studies about the efficacy of androgen replacement therapy (ART) on late-onset hypogonadism (LOH) have been conducted in Western countries, most of which were small-scale and short-term studies. It is, however, still controversial whether ART can improve healthcare and prolong an active lifestyle. On the other hand, there have been no large-scale randomized controlled trials (RCT) regarding the efficacy of ART on LOH in Asian populations. We prospectively assessed the effects of long-term ART on physical and mental status in aging males with LOH in Japan. METHODS A total of 334 eligible patients over 50 years old with LOH were randomly assigned to either the ART group (n = 169) with intramuscular injection of methyltestosterone 250 mg each time every four weeks up to 12 times, or a control group (n = 165) without ART. In all participants, quality-of-life (QOL) questionnaires: Short Form-36 Health Survey (SF-36) and Aging Males Symptoms (AMS) score as a primary end point, and glycemic control, lipid parameters, waist circumference, body mass index (BMI), muscular strength, International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF)-5 scores, bone mineral density (BMD), and serum prostate-specific antigen (PSA) levels as secondary end points were evaluated 52 weeks after initiation of treatment. In addition, we examined whether long-term ART was safe and tolerable in these populations. RESULTS With regard to QOL, ART had a significant effect and a marginally significant influence on Role Physical subdomain (P = 0.0318) and Role Emotional subdomain (P = 0.0727) of the SF-36 scale, respectively. ART was associated with a significant decrease from baseline to 52 weeks in waist circumstance related to metabolic syndrome (P = 0.002) and serum TG (P = 0.013), and with significant increases in muscle mass volume of the whole body and legs (P = 0.071 and 0.0108, respectively), serum Hb (P < 0.001), in voiding subscore of IPSS (P = 0.0418), and the second question of IIEF-5 (P = 0.0049). There were no significant differences between the 2 groups in BMI, BMD, isometric handgrip strength, serum BS and HbA1c, serum PSA, or the incidence of severe adverse events. CONCLUSIONS Long-term ART not only improves androgen deficiency-associated symptoms, but also comprehensively improves psychological issues. Further studies are needed to examine the mental status in patients with LOH, and we hope our study will be beneficial in this area. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e506 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hiroyuki Konaka Kanazawa, Japan More articles by this author Kazuhiro Sugimoto Kanazawa, Japan More articles by this author Kazuyoshi Sigehara Kanazawa, Japan More articles by this author Yoshifumi Kadono Kanazawa, Japan More articles by this author Eitetsu Koh Kanazawa, Japan More articles by this author Mikio Namiki Kanazawa, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Low-intermediate dose testosterone replacement therapy by different pharmaceutical preparations improves frailty score in elderly hypogonadal hyperglycaemic patients

An open-label follow-up study of low-to-intermediate dose testosterone replacement therapy (TRT) was conducted in 64 overweight patients (aged 65–75 years) with late onset hypogonadism (LOH) and increased fasting plasma glucose (FPG). Patients were subdivided into four treatment groups: oral testosterone (T) (T undecanoate, 80 mg/d), transmucosal T (60 mg/d), transdermal T (30 mg/d) or no treatment (control), and evaluated at 0 and 6 months. FPG, hemoglobin (Hb), prostate-specific antigen (PSA) and total T were measured and the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) index was calculated. Body mass index (BMI), waist circumference, fitness level (6-min walking test), Aging Males’ Symptoms (AMS) scale, handgrip strength and energy expenditure with physical activity (Minnesota questionnaire for Leisure Time Physical Activity (LTPA)) were evaluated and a “frailty score” (based on: grip strength, gait speed and LTPA) was calculated. T levels increased in all treatment groups; the oral T group had values still in the hypogonadal range (5.9 ± 1.1 nmol/L). PSA and Hb concentrations did not change in any group. BMI, waist circumference, FPG and HOMA-IR improved in all T-treated groups after 6 months, with a greater effect seen with transmucosal and transdermal T compared with oral T. This study indicates that low-to-intermediate dose TRT may be safely utilized in LOH patients to ameliorate somatic and psychological frailty symptoms in association with improved anthropometric and glycometabolic parameters in aging, overweight men with LOH and impaired fasting glucose.

211 Sexual dysfunction, aging male symptoms and their relationship to testosterone (T) in the Registry of Hypogonadism in Men (RHYME)

211 Sexual dysfunction, aging male symptoms and their relationship to testosterone (T) in the Registry of Hypogonadism in Men (RHYME)

A Prospective, Multicenter Study on Efficacy of Long-Acting Testosterone Undecanoate, If Desired in Combination with Vardenafil, in Late Onset Hypogonadal Patients with Erectile Dysfunction

Introduction: There is substantial evidence suggesting the additive effect on erectile function (ED) of testosterone and phosphodiesterase (PDE)-5 inhibitors. But the combination of long-acting testosterone undecanoate (TU), in combination with the PDE5-I vardenafil men with with late-onset hypogonadal patients (LOH) with (ED) has not yet been studied. Aims: To evaluate the effects of TU i.m., and if desired, the PDE5i vardenafil (PDE-5I) in LOH patients with ED measured with the International Index of Erectile Function (IIEF-5). Methods: A prospective study was performed following four administrations of TU in week 0, 6, 18, 30. If no improvement of ED assessed with IIEF-5 or the Global Assessment Questionnaire (GAQ) in week 12, the PDE5 inhibitor vardenafil was added. The final evaluation was in week 46. Main Outcome Measures: Aging Male Symptom (AMS) score, IIEF-5 score, and International Prostate Symptoms Score (IPSS) at each visit were summarized as mean with standard deviation; while GAQ was summarized using frequency and percentage. Scores at each visit were also categorized into different levels of symptom severity. Results: AMS score decreased significantly at week 12, 30 and 46. IIEF-5 score increased but a significant change was found only at week 30 and 46. The GAQ assessment indicated erection and sexual intercourse already improved at the first assessment continuing thereafter. IPSS score decreased from baseline at week 46. Levels of total, free and bioavailable testosterone had increased significantly from baseline at all visits. Hematocrit, hemoglobin and prostate specific antigen increased significantly from baseline. Adverse events were rare with pain at injection site found in one patient. The two events were non-serious in type, mild in their intensity and recovered. Conclusions: Therapy with TU and, and if desired, combined with the PDE5 inhibitor vardenafil improved sexual activity in LOH patients with ED.

Abstract OT2-2-05: A prospective, randomised multi-centre phase II study evaluating the adjuvant, neoadjuvant or palliative treatment with tamoxifen +/− GnRH analogue versus aromatase inhibitor + GnRH analogue in male breast cancer patients (GBG-54 MALE)

Abstract Background: Breast cancer (BC) in men is a rare disease accounting for 0.5–1% of all BC. The only available information on endocrine therapies derives from few retrospective case series and studies with small numbers of patients (pts). Treatment strategies are not based on data from prospective, randomised clinical studies and optimal therapy is unknown. Current clinical management is extrapolated from principles established for female BC. As 90% of male pts have hormone receptor positive BC, they receive tamoxifen 20mg as standard adjuvant therapy. Although women benefit from treatment with aromatase inhibitors (AI), only case reports exist of men treated with AI. Data from other entities show, that AI only suppresses oestradiol of 40–50% with an increase of testosterone. Among men on AIs, the hypothalamic-pituitary feedback loop results in an increase substrate for aromatisation. By adding a gonadotropin-releasing hormone analogue (GnRH), the feedback loop would be interrupted and complete oestrogen suppression may be achieved. Patients and Methods: The MALE study is a prospective, randomized, phase II study in which 48 male pts will be included in the adjuvant, neoadjuvant and metastatic setting. In a 3-arm design, endocrine therapies are compared consisting of tamoxifen 20mg daily versus tamoxifen daily+GnRH on day 1 and after 3 months versus exemestane 25mg daily+GnRH on day 1 and after 3 months. The treatment duration is 6 months. The primary aim is to determine the oestradiol suppression after 3 months. Secondary endpoints are to compare the oestradiol suppression after 6 months and to assess the compliance (with standardized questionnaires as Aging Male Symptom Score, International Index of Erectile function and International Prostate Symptom Score), safety and toxicity profile. The determination of the predefined hormones at baseline and after 3 and 6 months will be measured centrally. After the antihormonal treatment, all pts should be treated according to local recommendations. Included can be men with primary or metastatic endocrine sensitive BC with an indication of an endocrine therapy who did not receive prior antihormonal therapy; prior chemotherapy is allowed. 16 evaluable pts per group are needed for the Kruskal-Wallis-Test to have 80% power to detect at the 5% significance level a difference. The translational research programme includes the determination of cytochrome P450 polymorphisms, the hormone receptor activity and aromatase expression of the tumour tissue. Results: The time of recruitment should not exceed 2 years with 36 recruiting sites in Germany. As no study specific treatment or investigation is planned after the end of treatment, surgery and follow up are not part of this study, however information on the health status of the pts will be collected. The trial has been opened in May 2012 and is currently recruiting. Conclusion: This is the first study randomizing men with BC to investigate the ability to suppress estradiol of different endocrine regimen. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr OT2-2-05.

Effects of short-term testosterone administration on variables of the metabolic syndrome, in particular aldosterone.

Abstract Background: The ATPIII criteria of the metabolic syndrome (MS) comprise impaired fasting glucose (>5.6 nmol/L), waist circumference >102 cm, hypertension (>130/85 mm Hg), high triglycerides (>1.7 nmol/L) and low HDL cholesterol (≤1.03 nmol/L). Aldosterone is currently recognized as a key factor in the pathogenesis of cardiovascular diseases and insulin resistance, linking hypertension to MS and obesity. Further, the MS is related to psychological functioning. Forty-two men older than 40 years with BMI >30 kg/m2, chronic heart failure (CHF) and serum testosterone (T) <12.0 nmol/L were recruited. Of these 42, 26 consented to T treatment and received two injections with T undecanoate 1000 mg. Biochemical variables relevant for the MS and also serum aldosterone were determined before and after injections; an echocardiography and Aging Males' Symptoms (AMS) scale were also utilized. After 24 weeks of testosterone administration, there were significant declines of insulin and homeostatic model assessment and of serum aldosterone, but no changes in blood pressure. Serum glucose declined but not significantly (p=0.073). There was a slight increase in LDL cholesterol and a decrease in triglycerides. Other variables of MS and other biochemical variables did not change. Echocardiographical variables did not change. The AMS showed improvements over the first 3 months after testosterone administration but, although sustained, there was no further improvement. Short-term testosterone administration over 24 weeks led to some improvements of variables of the MS, notably of aldosterone. Longer-term studies are needed to analyze whether the decrease in serum aldosterone will improve blood pressure and glycemic control.

The Comparison of the Aging Male Symptoms (AMS) Scale and Androgen Deficiency in the Aging Male (ADAM) Questionnaire to Detect Androgen Deficiency in Middle‐Aged Men

The prevalence of androgen deficiency in men increases with aging. Two common instruments, the Aging Male Symptoms (AMS) scale and the Androgen Deficiency in the Aging Male (ADAM) questionnaire, are often used to screen for androgen deficiency in clinical practice. The aim of this study is to compare the capability of the AMS scale and the ADAM questionnaire to detect androgen deficiency in middle-aged Taiwanese men. In April 2008, a free health screening was conducted by Kaohsiung Medical University Hospital. All participants completed a health questionnaire and had blood samples drawn between 8:00 am and noon. Serum total testosterone (TT), albumin, and sex hormone-binding globulin levels were measured. The level of free testosterone (FT) was calculated. Clinical symptoms associated with androgen deficiency were screened by using the AMS scale and ADAM questionnaire. Androgen deficiency was defined as TT < 300 ng/dL or both TT < 300 ng/dL and FT< 5 ng/dL. In total, 339 men were included in the final analysis, with the mean age of 54.6 ± 4.9 years (range, 47-65 years). Androgen deficiency was found in 75 men (22.1%) based on the criteria of TT < 300 ng/dL, and in 54 men (15.9%) based on the criteria of TT < 300 ng/dL and FT < 5 ng/dL. When detecting participants with both TT < 300 ng/dL and FT < 5 ng/dL, the sensitivity and specificity of the AMS scale were 57.4% and 48.1%, compared with 66.7% and 25.6% for the ADAM questionnaire. In a sample of middle-aged Taiwanese men, neither the AMS scale nor the ADAM questionnaire had sufficient sensitivity and specificity to detect androgen deficiency. In addition to using those 2 screening instruments, a thorough physical and biochemical workup should still be conducted in patients at risk or suspected of androgen deficiency.

Job demands as a potential modifier of the association between testosterone deficiency and andropause symptoms in Japanese middle-aged workers: A cross-sectional study

ObjectiveThe present study investigated whether job demands modify the association between low levels of testosterone and andropause symptoms. Study designParticipants were Japanese middle-aged workers in a middle-size company. Blood samples were drawn to determine serum levels of testosterone. Participants completed a self-report questionnaire that included 5 items from the Job Content Questionnaire (JCQ) that assesses job demands, the Aging Males’ Symptoms (AMS) scale as well as questions regarding health behaviors and history of disease. Analysis of data was limited to the 183 men who completed all components of the questionnaire and provided blood samples (mean age=51.9 years, SD=7.7, age range 34–67 years). Main outcome measuresThe AMS which comprises three symptom sub-scales: somatic, psychological, and sexual. ResultsMen with low testosterone levels (<349ng/dL) had more psychological andropause symptoms than those with high levels. In men with high psychological job demands, compared to men with low job demands, testosterone levels were positively associated with the total score for andropause symptoms and scores for somatic and psychological symptoms. ConclusionsLevel of job demands may intensify the effect of testosterone deficiency on andropause symptoms.

Sexual hormones and erectile function more than 6 years after bariatric surgery

BackgroundThe long-term effect of bariatric intervention on androgenic hormones and erectile function is not well known. In a prospective comparative study, the profile of sexual function was ascertained. The setting was a large public academic hospital. MethodsA total of 51 patients were included in the present study. Of these, 23 were in the bariatric surgery cohort (with 6–14 yr of follow-up), 14 were obese controls, and 14 were lean controls, aged 30–65 years. The groups were matched for age and, in the case of obese controls, the current body mass index. The measurements included orchidometry, an assessment of gynecomastia, the International Index of Erectile Function, the Aging Males Symptoms questionnaire, the measurement of 12 hormones, and general biochemical measurements. ResultsBariatric patients lost substantial weight (59.8 ± 12.1 versus 35.1 ± 7.7 kg/m2), albeit residual obesity was the rule, with varying degrees of sleep apnea, hypertension, and glucose/lipid aberrations. The total and free testosterone and sex hormone-binding globulin levels were greater in the gastric bypass patients than in the obese controls and comparable to those of lean individuals. The International Index of Erectile Function final score revealed no differences; however, the domains of erectile dysfunction (P = .015) and overall satisfaction (P = .028) were better than those in the obese controls, although still lower than those in the lean group. The correlation between the body mass index and the International Index of Erectile Function score in the entire population (n = 51) was negative, as expected, with, however, low r and r2 indexes (.354 and .125, respectively). ConclusionThe findings are consistent with long-term normalization of androgenic hormones but less than complete normalization of erectile function. This seeming contradiction might be explained by the remaining or relapsing obesity or its co-morbidities.

Effect of long-acting testosterone undecanoate treatment on quality of life in men with testosterone deficiency syndrome: a double blind randomized controlled trial.

This study aimed to investigate the effect of intramuscular injection of testosterone undecanoate on overall quality of life (QoL) in men with testosterone deficiency syndrome (TDS). A randomized controlled trial over a 12-month period was carried out in 2009. One hundred and twenty men aged 40 years and above with a diagnosis of TDS (serum total testosterone <12 nmol l(-1) and total Aging Male Symptom (AMS) scores ≥27) were invited to participate. Interventions comprised intramuscular injection of either placebo or 1000 mg testosterone undecanoate, given at weeks 0, 6, 18, 30 and 42. This paper presents the secondary analysis of QoL changes measured in the scores of Short-Form-12 (SF-12) scale at baseline, weeks 30 and 48 after the first injection. A total of 56/60 and 58/60 men from the active treatment and placebo group, respectively, completed the study. At week 48, before adjusting for baseline differences, the QoL of men in the treatment group improved significantly in five out of the eight domains on SF-12. The physical health composite scores improved 4.0 points from a baseline of 41.9±7.0 in the treatment group compared to 0.8 point from a baseline of 43.7±7.1 in the placebo group (F=3.652, P=0.027). The mental health composite scores improved 4.4 points from a baseline of 37.1±9.0 in the treatment group compared to 1.0 points from a baseline of 37.6±7.9 in the placebo group (F=4.514, P=0.018). After adjusting for baseline differences, significant improvement was observed in mental health composite scores, but not in physical health composite scores. Long-acting testosterone undecanoate significantly improved the mental health component of QoL in men with TDS.

1142 A PROSPECTIVE STUDY OF THE EFFECT OF 5-ALPHA-REDUCTASE INHIBITOR (DUTASTERIDE) TREATMENT ON SERUM FREE TESTOSTERONE LEVEL AND AGING MALE SYMPTOMS IN JAPANESE PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Evaluation I1 Apr 20121142 A PROSPECTIVE STUDY OF THE EFFECT OF 5-ALPHA-REDUCTASE INHIBITOR (DUTASTERIDE) TREATMENT ON SERUM FREE TESTOSTERONE LEVEL AND AGING MALE SYMPTOMS IN JAPANESE PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA Takahiro Maeda, Eiji Kikuchi, Masanori Hasegawa, Gou Kaneko, Kazunobu Shinoda, Hidaka Kono, Ryuichi Mizuno, Hirohiko Nagata, Hiroshi Asanuma, Akira Miyajima, Ken Nakagawa, and Mototsugu Oya Takahiro MaedaTakahiro Maeda Tokyo, Japan More articles by this author , Eiji KikuchiEiji Kikuchi Tokyo, Japan More articles by this author , Masanori HasegawaMasanori Hasegawa Tokyo, Japan More articles by this author , Gou KanekoGou Kaneko Tokyo, Japan More articles by this author , Kazunobu ShinodaKazunobu Shinoda Tokyo, Japan More articles by this author , Hidaka KonoHidaka Kono Tokyo, Japan More articles by this author , Ryuichi MizunoRyuichi Mizuno Tokyo, Japan More articles by this author , Hirohiko NagataHirohiko Nagata Tokyo, Japan More articles by this author , Hiroshi AsanumaHiroshi Asanuma Tokyo, Japan More articles by this author , Akira MiyajimaAkira Miyajima Tokyo, Japan More articles by this author , Ken NakagawaKen Nakagawa Tokyo, Japan More articles by this author , and Mototsugu OyaMototsugu Oya Tokyo, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1252AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The aim of the present study was to clarify the effects of dutasteride on serum free testosterone levels and aging male symptoms (AMS) in patients with benign prostatic hyperplasia (BPH). METHODS This prospective study was conducted in 155 men diagnosed with moderate to severe symptomatic BPH (IPSS>7 and peak urinary flow rate of <15 mL/s) and who visited our hospital from 2009 to 2011 and opted for medical treatment of BPH by dutasteride. For all patients, AMS questionnaires and serum free testosterone were checked at baseline and after 3 months of treatment. Repeated measure ANOVA test was used to analyze the effect of dutasteride on serum free testosterone level and the AMS scores. RESULTS Dutasteride treatment led to a modest, but significantly increase in serum free testosterone level from 7.8 pg/ml to 8.9 pg/ml (P<0.01). This increase was the greatest in patients who had low baseline levels of free testosterone and the rate of appreciation exceeded 25 %. Among the evaluable 119 patients before administration of dutasteride, AMS score was 17 to 26, 27 to 36, 37 to 49, and more than 49 were in 25, 53, 27, and 14 patients, respectively. Overall, dutasteride treatment significantly increased AMS sexual subscale score, but did not affect other subscale scores. We defined symptomatic testosterone deficiency syndrome (STDS) as the serum free testosterone of less than 8.5 pg/ml and baseline AMS score of 37 or more with poor morning erection. According to the criteria, 26 patients were diagnosed as STDS. The use of dutasteride on patients with STDS increased serum free testosterone level from 6.5 pg/ml to 7.3 pg/ml (p=0.03) and significantly decrease total AMS score from 47.7 to43.0 (p=0.01), physical subscale score and sexual subscale score (P<0.01). Patients were further divided into two groups by the magnitude for improvements of total AMS scores using a cut off 3 points. Sixteen patients had AMS improvements of 3 points or more and 10 with that of less than 3 points. In patients with AMS improvements of 3 points or more, serum free testosterone level significantly increased from 6.4 pg/ml to 7.5pg/ml (p=0.02) 3months after dutasteride treatment. Meanwhile, no significant change was observed on serum free testosterone level (p=0.89) in patients with AMS improvements of less than 3 points. CONCLUSIONS Our results show that dutasteride treatment in men with BPH led to significant increase in serum free testosterone level and a significant improvement of AMS scores among those with STDS. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e463 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Takahiro Maeda Tokyo, Japan More articles by this author Eiji Kikuchi Tokyo, Japan More articles by this author Masanori Hasegawa Tokyo, Japan More articles by this author Gou Kaneko Tokyo, Japan More articles by this author Kazunobu Shinoda Tokyo, Japan More articles by this author Hidaka Kono Tokyo, Japan More articles by this author Ryuichi Mizuno Tokyo, Japan More articles by this author Hirohiko Nagata Tokyo, Japan More articles by this author Hiroshi Asanuma Tokyo, Japan More articles by this author Akira Miyajima Tokyo, Japan More articles by this author Ken Nakagawa Tokyo, Japan More articles by this author Mototsugu Oya Tokyo, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

593 A prospective study of the effect of 5-alpha-reductase inhibitor (dutasteride) treatment on serum free testosterone level and aging male symptoms in Japanese patients with benign prostatic hyperplasia

593 A prospective study of the effect of 5-alpha-reductase inhibitor (dutasteride) treatment on serum free testosterone level and aging male symptoms in Japanese patients with benign prostatic hyperplasia

Assessment of the influence of socio-economic status on aging males’ symptoms in Ijesaland, South-Western Nigeria

BackgroundAging issues are becoming a very serious concern in many developing countries, particularly the health care needs and challenges of the elderly. Crucial among these are the sexual, psychosocial and somatic challenges facing the elderly, and the factors that may influence these. The Aging Males’ Symptoms (AMS) scale was primarily designed for international comparability on measures of quality of life (QoL) among the elderly. The validity and reliability of this instrument have been tested in Nigeria and results confirm its comparability with results from other countries. It is pertinent to examine the influence of some socio-economic factors on the self-reported severity of sexual, psychosocial and somatic measures on the AMS. MethodsThe AMS instrument was administered to 456 males aged 60 years and above in selected communities in Ijesaland, South-West Nigeria. The AMS has 17 items and scoring was done on a scale of 1–5 based on the level of severity. Three outcome variables for psychosocial, somatic and sexual scores were used together with socio-economic variables as co-variates. STATA 11 was used for the analyses, which included frequency distribution, chi-square test and logistic regression model. ResultsIn the bi-variate analysis, wealth index was the only statistically significant variable for predicting the odds of each of the three outcome variables. A logistic regression model showed that higher education and middle income were significant predictors of high severity on the psychosocial score. Oldest age group, polygamous union and a high wealth index were significant predictors of higher somatic scores. None of the co-variates were significantly associated with the sexual score. ConclusionThe study concluded that wealth index and other proxies of empowerment, such as education, to a great extent influence quality of life.

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.

Sex Hormone Levels, Genetic Androgen Receptor Polymorphism, and Anxiety in ≥50-Year-Old Males

While associations between somatic changes and sex hormone levels in aging men have been explored in many studies, the association of testosterone and estradiol with psychic symptoms other than depression and the role of the genetically determined CAG repeat (CAGn) polymorphism of the androgen receptor (AR) have received much less attention. The purpose of this article is to investigate the associations between general anxiety, phobic anxiety and panic with sex hormone levels and the genetic androgen receptor polymorphism in aging males. This cross-sectional study of males aged ≥50 years included 120 consecutive patients of the Department of Psychosomatics and Psychotherapy, 76 consecutive patients of the Andrology Clinic, and 100 participants from the general population; all of them completed the Brief Symptom Inventory (BSI), the Aging Males' Symptoms (AMS) Scale, and the Patient Health Questionnaire (PHQ-9). Morning blood samples were analyzed for total and free testosterone, estradiol, sex hormone-binding globulin (SHBG), and the CAGn AR polymorphism. Psychosomatic patients also underwent psychiatric assessment. Scores on the Anxiety subscales of the BSI and PHQ, Anxiety disorders according to International Classification of Diseases, 10th revision (ICD-10). The two clinical samples had significantly longer CAGn of the AR and higher anxiety levels compared to the population sample. Anxiety scores were positively correlated with CAGn in psychosomatic patients and in andrological patients, in the latter also with estradiol levels, while the population sample showed no significant correlations between anxiety scores, CAGn and sex hormones. Anxiety cases according to BSI, PHQ, and ICD-10 had significantly longer CAGn of the AR when compared to the other participants, but there were no significant differences in testosterone or free testosterone levels. Our results indicate that genetically determined long CAGn of the AR is an independent risk factor for higher anxiety, panic and phobic anxiety levels.

Survey for late-onset hypogonadism among old and middle-aged males in Shanghai communities

This study sought to investigate late-onset hypogonadism (LOH) in old and middle-aged males in Shanghai communities, using symptom score evaluation systems and measurements of sex hormone levels. One thousand cases of males aged 40-70 years were investigated. The aging male symptoms (AMS) scale and androgen deficiency in aging males (ADAM) questionnaire were used at the beginning of the investigation, followed by measurement of the sex hormone-related factors (total testosterone (TT), free testosterone (fT), sex hormone-binding globulin (SHBG) and bioavailability of testosterone (Bio-T)). There were 977 valid questionnaires. The LOH-positive rates shown by AMS and ADAM were 59.88% and 84.65%, respectively; values increased with the age of the patients. There were 946 results related to sex hormone measurements, which showed the following results: TT was not related to aging (P>0.05); levels of SHBG increased with age; and fT and Bio-T decreased with age. There was a significant difference in fT between LOH-positive and LOH-negative patients, as shown by the ADAM. In summary, TT levels were not related to aging, even though SHBG did increase while fT and Bio-T decreased with aging. Clinically, the diagnosis of LOH cannot be based on serum TT level.

Fertility and Gonadal Function After Treatment of Early Unfavorable Hodgkin Lymphoma (HL): An Analysis of the German Hodgkin Study Group (GHSG)

Abstract 432 Purpose:Two cycles of BEACOPPescalated followed by two cycles of ABVD (“2+2”) improves the primary outcome in early unfavorable HL patients as shown in the GHSG HD14 trial. Compared to 4xABVD, this benefit might be compromised by more gonadal toxicity in women and men. We thus analyzed gonadal function and fertility of survivors in the HD14 trial. Methods:Women between 18–40 years and men between 18–50 years at diagnosis in ongoing remission at least one year after therapy, treated with either 4xABVD (arm A) or “2+2” (arm B), were included. In women, different hormone parameters (follicle-stimulating hormone (FSH), Anti-Muellerian-Hormone (AMH)) as well as menopausal symptoms, prophylactic measures to preserve fertility, concurrent hormonal treatment, menstrual cycle, pregnancies, and offspring were evaluated. In men, serum levels of FSH, testosterone, and inhibin B were determined as well as symptoms of hypogonadism (aging males symptom scale, AMS) and children after therapy. Results:From a total of 579 women addressed, 331 participated in the present study (57%) and 263 per-protocol treated patients qualified for the comparison of treatment arms (A: 137, B: 126; mean time from end of therapy 42 and 43 months, respectively). The rates of regular menstrual cycle after treatment (A: 87%, B: 83%) and time to recovery (≤12 months) were not different. FSH and AMH, reflecting ovarian reserve, were significantly better in arm A and AMH levels were also low after 4xABVD in women >30 years. In contrast, pregnancies after therapy favored arm B (A: 15%, B: 26%, p=0.043) and motherhood rates were equivalent to the German normal population in both arms. A multivariate analysis revealed prophylactic use of GnRH-analogues as highly relevant and significant prognostic factor for preservation of fertility (OR=12.87, p=0.001). Severe menopausal symptoms were reported frequently in women ≥30 years (A: 21%, B: 25%). From a total of 592 men addressed, 322 participated in the present study (54%) and 235 per-protocol treated patients qualified for the comparison of treatment arms (A: 111, B: 124; mean time from end of therapy 43 and 45 months, respectively). Levels of FSH (A: 4.3 U/l, B: 7.7 U/l, p<0.001) and inhibin B (A: 140.7 ng/l, B: 46.9 ng/l, p<0.001) were significantly better in arm A and children after therapy were also more frequently reported after treatment with 4xABVD (A: 12%, B: 5%, p=0.075). However, levels of testosterone and symptoms of hypogonadism were not different between treatment arms. In addition, symptoms of hypogonadism were equivalent as compared to the reference population. Conclusion:With focus on hormonal markers, results of the present study demonstrate higher gonadal toxicity in women and men after the “2+2” regimen compared to 4xABVD. Accordingly, in men, more children after 4xABVD are reported. In women, fertility is not compromised within the evaluated observation time, especially when GnRH-analogues were used. Disclosures:No relevant conflicts of interest to declare.

A randomized, double‐blind, placebo‐controlled trial on the effect of long‐acting testosterone treatment as assessed by the Aging Male Symptoms scale

Study Type - Therapy (RCT). Level of Evidence 1b. What's known on the subject? and What does the study add? Testosterone deficiency syndrome can be treated with testosterone replacement in the form of injectable, transdermal, buccal and oral preparations. Long-acting i.m. testosterone undecanoate 1000 mg, which is given at 10-14 week intervals, has been shown to be adequate for sustaining normal testosterone levels in hypogonadal men. This study confirms that long-acting i.m. testosterone undecanoate is effective in improving the health-related quality of life in men with testosterone deficiency syndrome as assessed by the improvement in the Aging Male Symptoms scale. Testosterone treatment can be indicated in men who have poor health-related quality of life resulting from testosterone deficiency syndrome. • To evaluate the effect of i.m. injection of testosterone undecanoate 1000 mg over 12 months on the Aging Male Symptom (AMS) scale scores in men with testosterone deficiency syndrome (TDS). • A total of 120 men >40 years old with TDS (total testosterone < 12 nmol/L and total AMS scores ≥ 27) were randomized into i.m. injection of either placebo or testosterone undecanoate 1000 mg. • In all, 56 and 58 participants from the active treatment and placebo groups, respectively completed the study. • An i.m. injection of either placebo or testosterone undecanoate 1000 mg was given at weeks 0, 6, 18, 30 and 48. • Self-administered AMS questionnaires were completed at weeks 0, week 18 and week 48. • Improvement in the total AMS score was significantly greater in the treatment group than in the placebo group (F: 4.576, P= 0.017) over the 48-week period. • The mean (sd) total AMS score was 38.46 (11.85) at baseline and 33.59 (1.69) at 48 weeks for the placebo group, and 41.73 (12.73) at baseline and 32.61 (9.67) at 48 weeks for the treatment group. • The mean change in the total AMS score was -12.6% in the placebo group and -21.9% in the treatment group. • The mean psychological and somatovegetative domain scores decreased significantly more in the treatment group than in the placebo group (-2.8 vs -1.2, P= 0.03; and -3.2 vs -1.8, P= 0.016). • The difference in change between the randomized groups for the sexual domain scores followed the same trend, though the difference was not significant. • Long-acting testosterone is effective in improving health-related quality of life as assessed by the AMS scale in men with TDS.

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

Introduction: Issues of men’s health have been greatly researched by scholars in recent decades. At men’s health clinics, many patients complain of both insomnia and aging males’ symptoms (AMS). These symptoms might be influenced by biological, psychological or even social factors. The aim of this study was to investigate different aspects of the relationship between insomnia and aging symptoms. Methods: This cross-sectional study included 231 males from a men’s health clinic. Participants completed a set of general data and screening assessments, including the AMS rating scale, insomnia severity index (ISI), Beck depression inventory-II (BDI-II) and Beck anxiety inventory Chinese version (BAI), to investigate the severity of aging symptoms, insomnia, depression and anxiety. Results: The ISI correlated significantly with the AMS scale, both with (partial correlation coefficient = 0.470) and without (r = 0.580) controlled variances of depression and anxiety. Using linear regression, aging symptoms were statistically predicted by the severity of the ISI, and a substantial proportion of the variance was explained (adjusted R2 = 0.410). When all variables were included, this proportion rose to 55.3% (adjusted R2 = 0.553). Conclusion: We suggest that insomnia is a good predictor of aging symptoms across all age groups of men.

Testosterone replacement improves Sexual Function, Aging Male Symptom and Depression Scores in a primary care population of men with type 2 diabetes

Testosterone replacement improves Sexual Function, Aging Male Symptom and Depression Scores in a primary care population of men with type 2 diabetes