Men's Health Clinic Research Articles

Prevalence and Predictors of Climacturia and Associated Patient/Partner Bother in Patients With History of Definitive Therapy for Prostate Cancer

BackgroundClimacturia is an under-reported complication of definitive therapy for prostate cancer (PCa) - that is, radical prostatectomy (RP) and/or radiation therapy (RT). AimWe sought to identify the prevalence and predictors of climacturia and associated patient/partner bother in patients with and without prior PCa treatment. MethodsWe analyzed a database of patients who presented to our Men's Health clinic and filled out a questionnaire related to sexual function and pertinent medical histories. The prevalence of climacturia and associated patient/partner bother in patients with/without prior RP/RT was calculated. Univariable and multivariable logistic regressions were performed to identify predictors associated with climacturia and patient/partner bother. OutcomesThe primary outcomes were the prevalence and predictors of climacturia and associated patient/partner bother in patients with/without history of definitive PCa treatment. ResultsAmong 1,117 patients able to achieve orgasm, 192 patients (17%) had prior history of definitive therapy for PCa (RP alone = 139 [72%]; RT alone = 22 [11%]; RP + RT = 31 [16%]). Climacturia was reported by 39%, 14%, 52%, and 2.4% of patients with history of RP alone, RT alone, RP + RT, and neither RP nor RT, respectively (P < .05 between all groups). 33 to 45 percent of patients with climacturia noted significant patient/partner bother. Factors significantly associated with climacturia were prior RP, prior RT, history of other prostate surgery, and erectile dysfunction, although erectile dysfunction was not significant on multivariable analysis. Significant reduction in climacturia prevalence was noted for patients who were ≥1 year out from RP, compared with patients who were <1 year out.Among patients with prior RP/RT, stress urinary incontinence was associated with increased risk of climacturia, whereas diabetes was associated with decreased risk. No factors were associated with patient/partner bother. Among patients with prior RP, nerve-sparing technique did not predict presence of climacturia but was associated with reduced patient/partner bother. Clinical translationGiven significant prevalence of climacturia and associated patient/partner bother, patients should be counseled on the risk of climacturia before undergoing RP/RT. Strengths and limitationsStrengths include the large study population and the focus on both RP and RT. Limitations include the facts that this is a single-institution study that primarily relies on patients’ subjective reporting and that the study population may not represent the general population. ConclusionsClimacturia affects a significant proportion of patients with history of RP/RT for PCa, and many patients and their partners find this bothersome.Jimbo M, Alom M, Pfeifer ZD, et al. Prevalence and Predictors of Climacturia and Associated Patient/Partner Bother in Patients With History of Definitive Therapy for Prostate Cancer. J Sex Med 2020;17:1126–1132.

Current and future trends in men's health clinics.

Men’s health is a unique field that requires a multi-disciplinary approach to appropriately treat the full spectrum of men’s health needs. Given that interest in men’s health is relatively new, the definition of a men’s health clinic continues to evolve. Originally conceived as testosterone replacement centers, men’s health clinics are increasingly understood to encompass male endocrine, surgical, urologic, physical performance, and psychological issues. As interest in men’s health continues to grow, it is important to focus on the field’s future, including pharmacies, telemedicine, and the diffusion of healthcare.

Intercourse frequency among men presenting to a sexual health clinic: does age matter?

We assessed the association between intercourse frequency and sexual function among 583 consecutive males with sexual partners presenting to a men's health clinic over a 2-year period. Median age was 62 and men reported a median of 2 (IQR 0, 5) episodes of intercourse per month. Younger age, shorter relationship duration, higher intercourse satisfaction (IIEF-IS) scores, and higher libido (all p < 0.01) were associated with more frequent intercourse. On multivariable analysis, longer relationship duration was associated with less frequent intercourse (p = 0.03), but was linked to higher overall sexual satisfaction. Age was not a significant predictor of intercourse frequency.

‘I don't care if you think I'm gay … that won't make me either promiscuous or HIV positive’: HIV, stigma, and the paradox of the gay men's sexual health clinic - An exploratory study

Young gay men are affected by HIV. Due to a lack of studies on these males, and that previous research notes youth's minimal healthcare seeking, we recruited young gay men at a gay men's STI testing clinic to explore their perceptions of care. Eight men participated in semi-structured interviews. Our results identified that, while our participants experienced stigma in some interactions, particularly when healthcare workers emphasized the probability of contracting HIV for gay men, overall they reported positive experiences with healthcare providers, particularly at the gay men's STI clinic. The gay men's STI clinic diminishes stigma and promotes HIV testing among a group of gay male youth who are affected by HIV, while its very existence propagates the association between gay males and HIV that most of the participants found stigmatizing. The association between sexuality and HIV was reported as stigmatizing in some situations, while the construction of a clinic on the premise that gay men require such testing was not. This reinforces the idea that stigma is a personal experience independent of action and locale.

Patients presenting to a Men's Health clinic are at higher risk for depression, insomnia, and sleep apnea.

Depression and sleep problems are highly prevalent disorders that are often comorbid with other medical disorders. We evaluated the prevalence and associations of these conditions in patients presenting to a Men's Health clinic. In this retrospective study, 124 patients presenting to a Men's Health clinic completed three urological questionnaires (International Index of Erectile Function [IIEF-5], International Prostate Symptom Score [IPSS], and Androgen Deficiency in Aging Males [ADAM]); and four non-urological questionnaires (Patient Health Questionnaire for depression [PHQ-9], STOP-BANG Sleep Apnea [OSA STOP-BANG], Insomnia Severity Index [ISI], and Epworth Sleepiness Scale [ESS]). Questionnaire results were evaluated in conjunction with patient clinical history and associated laboratory values via univariate and multivariate analysis. The mean age of the study participants was 54.1 years (SD 16). Comorbidities included hypertension (22.5%), vascular disease (15%), and diabetes mellitus (13.3%). Body Mass Index (BMI) was >25 in 77.3%. IIEF-5 scores were moderate-severe in 47.9%, ADAM questionnaire was positive in 79%, and IPSS scores were moderate-severe in 42.9% of patients. PHQ-9 demonstrated mild-severe depression in 38.6%, STOP-BANG showed intermediate-high risk for sleep apnea in 55.2%, ISI indicated moderate-severe insomnia in 18.1%, and ESS revealed mild-severe sleepiness in 16.6% of participants. On univariate analysis, BMI was associated with scores on the PHQ-9 (p = 0.035), STOP-BANG (p < 0.001), and ESS (p < 0.006). On multivariate analysis, positive ADAM questionnaire was associated with STOP-BANG (OR 3.29, 95% CI: 1.012-10.69), and IPSS with PHQ-9 (OR 4.64, 95% CI: 1.40-15.43) and ISI (OR 3.27, 95% CI: 1.06-10.1). Overall, patients presenting to a Men's Health Clinic were found to have high prevalence rates for risk of depression, insomnia and sleep apnea. Risks were elevated in older subjects, and those with increased BMI, hypogonadism, and lower urinary tract symptoms. Appropriate screening and referral to appropriate specialists are encouraged.

668 Peyronie's Disease is common in poorly controlled diabetics but is not associated with the metabolic syndrome

The root cause of Peyronie's disease (PD) is unknown. Many theories have been advocated for its etiology, but the most widely accepted is trauma to the tunica albuginea. Because prevalence varies widely, the potential for contributory cofactors/comorbidities has been proposed. We hypothesized that metabolic syndrome and other systemic comorbidities may be found at higher rates in the PD population, and endeavored the largest descriptive study ever to test this hypothesis. A retrospective chart review of 1833 patients presenting to a men's health clinic with a variety of complaints: erectile dysfunction (ED), premature ejaculation (PE), premarital checkup, small penis, decreased libido, lower urinary tract symptoms (LUTS) and PD were screened for PD. Variables collected: presence/absence of diabetes mellitus (DM), hypertension (HTN), dyslipidemia (DL), body mass index (BMI), total testosterone (T), penile peak systolic velocity (PSV), end diastolic velocity (EDV) in patients with ED and/or PD, smoking, glycosylated hemoglobin level (HbA1c) in patients with diabetes, and the presence of metabolic syndrome. Patients with PD were compared to patients without PD.

034 Prospective Evaluation of Depression and Sleep Disorders in Patients Presenting to a Men's Health Clinic

Depression and sleep disorders are becoming progressively prevalent. We sought to critically evaluate the prevalence and potential associations of these conditions in patients presenting to a Men's Health clinic. Between 11/2016 and 1/2017, 124 consecutive new patients presenting to a Men's Health clinic were asked to fill 3 urological (International Index of Erectile Function [IIEF-5], American Urological Association Symptom Index [AUA-SI] and Androgen Deficiency in Aging Males [ADAM]) and 4 non-urological questionnaires (Patient Health Questionnaire for depression [PHQ-9], STOP-BANG Sleep Apnea [OSA STOP-BANG], Insomnia Severity Index [ISI] and Epworth Sleepiness Scale [ESS]). Other demographic, clinical and diagnostic variables such as serum hormone levels were also prospectively collected. Co-morbidities included hypertension in 23%, vascular disease in 15% and diabetes mellitus in 13%. Body Mass Index (BMI) was 18.5-24.9 in 23%, 25-29.9 in 50% and ≥30 in 23%. Mean total serum testosterone was 411.9ng/dL (SD 393), Estradiol 39.2pg/mL (31.1) and Hemoglobin A1C 6.2% (1.3). IIEF-5 scores were moderate-severe in 48%, ADAM questionnaire was positive in 79% and AUA-SI scores were moderate-severe in 45% of patients. PHQ-9 demonstrated mild-severe depression in 39%, OSA STOP-BANG intermediate-high risk sleep apnea in 55%, ISI moderate-severe insomnia in 19% and ESS mild-severe excessive sleepiness in 17% of participants. On univariate analysis, age was associated with PHQ-9 and OSA STOP-BANG (p <0.001), vascular disease with OSA STOP-BANG (p <0.0011), and BMI with PHQ-9 (p 0.035), OSA STOP-BANG (p <0.001) and ESS (p 0.006). Using logistic regression models, a positive ADAM questionnaire was associated with OSA STOP-BANG (OR 3.29, 95%CI: 1.012-10.69), and AUA-SI with PHQ-9 (OR 4.64, 95%CI: 1.40, 15.43) and ISI (OR 3.27, 1.06-10.1).

The utility and feasibility of assessing sleep disruption in a men's health clinic using a mobile health platform device: A pilot study.

Evidence linking sleep disruption and sexual dysfunction in men is mounting; yet the characterisation of sleep patterns and complaints utilising a clinically feasible method within this patient population remain largely under-reported. A pilot study aiming to demonstrate a clinically feasible method to characterise the sleep patterns and complaints in a representative sample of patients treated in a men's health clinic. Male patients (n=48) completed a battery of validated sleep questionnaires using an mHealth mobile platform, MySleepScript, at the Johns Hopkins Men's Health and Vitality Center. Metrics related to clinical feasibility such as completion time, ease of use, preference of electronic format, and patient satisfaction were also collected. Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Berlin Questionnaire, Patient Health Questionnaire (PHQ-9), and Primary Care PTSD Screen (PC-PTSD). Primary urological chief symptoms for this sample patient population were erectile dysfunction (ED; 80%), hypogonadism (40%), benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS; 40%) and Peyronie's disease (10%). Mean PSQI score was 7.8 [SD 4.2], with 67% of all patients falling within the "poor sleeper" range. At least mild symptoms of depression were noted in 40% and 43% were at risk for obstructive sleep apnea (OSA) on the Berlin Questionnaire. This pilot study demonstrated the feasibility and potential utility of an mHealth platform to assist clinicians, within a men's health clinic, in detecting sleep disturbances. Disrupted sleep was revealed in well over half of this sample of patients. As a result of the growing evidence linking poor sleep and sleep disorders (eg, OSA) to the conditions relevant to men's health (eg, erectile dysfunction, hypogonadism and BPH), further efforts beyond this pilot study are necessary to identify the aetiological processes underlying the association between specific disrupted sleep disorders and urological conditions.

MP91-08 COMBINATION OF METABOLIC SYNDROME COMPONENTS TO PREDICT TESTOSTERONE DEFICIENCY IN MEN

You have accessJournal of UrologySexual Function/Dysfunction: Medical, Hormonal & Non-surgical Therapy I1 Apr 2017MP91-08 COMBINATION OF METABOLIC SYNDROME COMPONENTS TO PREDICT TESTOSTERONE DEFICIENCY IN MEN Eduardo P Miranda, Carina Oliveira, Evanilda Carvalho, Alessandra Rabelo, Aline Xavier, Ricardo Tiraboschi, Victor Paschoalin, Jose Murillo Bastos-Netto, Cristiano Gomes, and Jose Bessa Junior Eduardo P MirandaEduardo P Miranda More articles by this author , Carina OliveiraCarina Oliveira More articles by this author , Evanilda CarvalhoEvanilda Carvalho More articles by this author , Alessandra RabeloAlessandra Rabelo More articles by this author , Aline XavierAline Xavier More articles by this author , Ricardo TiraboschiRicardo Tiraboschi More articles by this author , Victor PaschoalinVictor Paschoalin More articles by this author , Jose Murillo Bastos-NettoJose Murillo Bastos-Netto More articles by this author , Cristiano GomesCristiano Gomes More articles by this author , and Jose Bessa JuniorJose Bessa Junior More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2848AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Studies have demonstrated that metabolic syndrome (MetS) is associated with low testosterone (T) levels. However the incremental effect of every MetS component in predicting testosterone deficiency (TD) has not been well explored in the literature. The primary goal of this study was to investigate the association of MetS and low T levels in men from 40 to 80 years of age, while investigating the cumulative effect of the syndrome components METHODS We reviewed records of all men who presented to our men's health clinic from January 2014 to August 2016. We evaluated age, presence of hypertension, waist circumference (WC), blood glucose level and the serum lipid profile (HDL and triglycerides - TGL), and MetS was considered present when 3 or more factors were present. TD was defined as serum total T <300 ng/dL. Univariable analyses were performed to assess the association variables and T levels. ROC curves analyses were performed to evaluate diagnostic accuracy of each MetS component in predicting TD. RESULTS The study comprised 902 men with a mean age of 57.2 ± 9.85 years. The overall prevalence of low T levels was 23.4% and it was similar across all age subgroups: age 40-49 years (y) 22.7%, 50-59y 23.1%, 60-69y 23.8%, and 70-79y 24.4%, p=0.25. The diagnosis of MetS was established in 27.9% of subjects and was associated with TD (OR=3.1, 95%CI 1.2-4.0, p<0.001). The prevalence of each MetS components was: hypertension = 43.6%, increased WC (>102) = 34.5%%, elevated glucose levels (>100 ng/dl) =33,8%, low HDL (< 40 mg/dL) = 25%, and high TGL (> 150 mg/dL) = 53.2%. Median T levels for patients with 5 MetS components was 293 ± 147 ng/dL, 4 = 306 ± 173 ng/dL, 3 = 356 ± 154 ng/dL, 2 = 387 ± 184 ng/dL, 1 = 421 ± 215 ng/dL, 0 = 460 ± 222 ng/dL. Accordingly, TD prevalence for subjects with none MetS components was 9.6%, 1 = 15.4%, 2 = 24%, 3 = 29%, 4= 48%, and 5= 52%. Increased WC was the most accurate predictor of TD in our population. The overall accuracy estimates by area under ROC curve was 0.716(0.686-0.745)95%CI. Diagnostic accuracy measurements of cumulative MetS components are demonstrated in Table 1. CONCLUSIONS There is an increased prevalence of TD with increasing number of MetS components. WC was the best predictor of TD in our population and age was not associated with lower T levels © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1221 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Eduardo P Miranda More articles by this author Carina Oliveira More articles by this author Evanilda Carvalho More articles by this author Alessandra Rabelo More articles by this author Aline Xavier More articles by this author Ricardo Tiraboschi More articles by this author Victor Paschoalin More articles by this author Jose Murillo Bastos-Netto More articles by this author Cristiano Gomes More articles by this author Jose Bessa Junior More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Association of Free Testosterone With Hypogonadal Symptoms in Men With Near-normal Total Testosterone Levels

To investigate the association between hypogonadal symptoms and free testosterone (FT) levels in men with near-normal total testosterone (T) levels (250-350ng/dL) and to determine whether a discriminatory threshold for FT exists below which hypogonadal symptoms become more prevalent. We reviewed the charts of 3167 men who presented to an outpatient men's health clinic. Two hundred thirty-one men had symptoms of "low testosterone" and serum testosterone levels between 250 and 350ng/dL. We evaluated hypogonadal symptoms using the Androgen Deficiency in the Adult Male (ADAM) and quantitative ADAM (qADAM) questionnaires. Serum levels of T and sex hormone-binding globulin were collected on the same day that men completed their questionnaires. We used linear regression to determine whether a threshold of FT exists for hypogonadal symptoms. We performed univariate and multivariable analyses to evaluate factors that predicted a low FT level. The median age was 43.5years, and the median testosterone and FT levels were 303ng/dL and 6.3ng/dL, respectively. Prevalence and severity of hypogonadal symptoms (ADAM and qADAM) were similar between men with low (<6.4ng/mL) and normal FT levels. There was an association between age and 3 of the 10 hypogonadal symptoms (decreased enjoyment in life, sadness, and deterioration of work performance) with a low FT on a univariate analysis. Only younger age was positively associated with FT on multivariable analysis. We did not observe a relationship between hypogonadal symptoms and FT in men with near-normal testosterone levels. Symptom-specific FT thresholds could not be defined, as age remains an important confounder.

PD36-08 LOW OSTEOCALCIN LEVELS ARE AN INDEPENDENT FACTOR ASSOCIATED WITH ANDROGEN DEFICIENCY

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Basic Research II1 Apr 2015PD36-08 LOW OSTEOCALCIN LEVELS ARE AN INDEPENDENT FACTOR ASSOCIATED WITH ANDROGEN DEFICIENCY Brian Le, Haolin Chen, Kevin Billups, Arthur L. Burnett, and Barry Zirkin Brian LeBrian Le More articles by this author , Haolin ChenHaolin Chen More articles by this author , Kevin BillupsKevin Billups More articles by this author , Arthur L. BurnettArthur L. Burnett More articles by this author , and Barry ZirkinBarry Zirkin More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2257AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Osteocalcin (OC) is a bone turnover marker that has recently been found in mice to be a novel regulator of testosterone production through a previously orphaned G-protein coupled receptor. Seeking to characterize OC's role in age-related androgen deficiency we conducted a bench to bedside study using serum samples from a prospective cohort of men being evaluated for hypogonadism and further investigated these findings in a rat model of androgen deficiency. METHODS We prospectively enrolled men who presented to the Johns Hopkins Men's Health Clinic who were being evaluated for symptomatic hypogonadism. Serum T, free T, SHBG, bioavailable T, and OC were obtained from blood samples and assayed using commercial laboratory techniques. Data were analyzed using Pearson's correlation, fisher's transformation and t-tests. Brown-Norway (BN) rats, like humans, have an age-related decline in testosterone production. We hypothesized that in our rat model of age-related hypogonadism OC levels would be lower in older rats, like in humans. We then altered serum testosterone levels acutely in vivo to examine its effects on serum OC. Lastly, we injected recombinant rat OC to examine its effects on T levels. RESULTS Ninety-two men were enrolled to participate in this prospective longitudinal cohort study. Total T and OC demonstrated a positive linear relationship with a correlation coefficient of R=0.57 (95% CI 0.39-0.71). Free T and OC were also correlated at R=0.47 (95% CI 0.27-0.63). Men with total T 350 ng/dl or less had significantly lower OC levels than eugonadal men (13.1 vs. 19.1 p<0.01). Similar to humans, in aged rats serum testosterone was lower compared to young rats (4.19 vs. 1.15 ng/ml p< 0.01). Serum OC levels were also lower in aged rats (1.81 vs. 0.97 ng/ml P<0.01). In old rats treated with a transporter protein (TSPO) ligand, serum testosterone increased 43%, while serum OC levels remained unchanged (0.93 vs.090 p = 0.93). In young rats treated with silastic T implants, serum OC levels decreased (2.19 vs 1.70 p =0.06) demonstrating OC is independent of T. Direct injection of recombinant OC did not acutely raise serum T levels versus placebo. CONCLUSIONS Androgen deficiency, and in particular lower free T, is associated with lower osteocalcin levels. In rats as well as humans, OC strongly correlates with serum T levels, and appears to do so independently of perturbations of T levels. This provides evidence to OC being a potential novel target pathway for treating androgen deficiency. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e768 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brian Le More articles by this author Haolin Chen More articles by this author Kevin Billups More articles by this author Arthur L. Burnett More articles by this author Barry Zirkin More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Hypogonadal symptoms in young men are associated with a serum total testosterone threshold of 400 ng/dL.

To investigate the association between hypogonadal symptoms and serum total testosterone (TT) levels in young men (aged <40 years), in an attempt to determine whether there exists a clear-cut discriminatory threshold of TT below which hypogonadal symptoms become more prevalent. We retrospectively reviewed the charts of 352 men who presented to an outpatient Men's Health Clinic with chief complaint of 'low testosterone'. Sexual, psychological and physical symptoms were evaluated using the Androgen deficiency in Aging Male (ADAM) questionnaire. Serum levels of TT were collected on the same day that men completed their ADAM questionnaires. We subsequently performed univariate (t-test, chi-square) and multivariate analyses (ordinal logistic regression) to evaluate factors that predicted a low TT level. The probability of hypogonadal symptoms increased at a serum TT level of 400 ng/dL. A cluster of symptoms: two psychological ('decreased energy', 'sadness'), and three physical ('decreased strength and endurance', 'decreased ability to play sports', and 'deterioration in work performance') were most strongly associated with serum TT levels of <400 ng/dL. On multivariable analysis, only 'lack of energy' predicted a TT level of <400 ng/dL. Hypogonadal symptoms in men aged <40 years can be associated with a TT level of <400 ng/dL. Of the hypogonadal symptoms evaluated with the ADAM questionnaire, 'lack of energy' appears to be the most important symptom that predicts a TT level of <400 ng/dL.

Doctors’ approaches to PSA testing and overdiagnosis in primary healthcare: a qualitative study

Objectives(1) To explain general practitioners’ (GPs’) approaches to prostate-specific antigen (PSA) testing and overdiagnosis; (2) to explain how GPs reason about their PSA testing routines and (3) to explain how...

Hypogonadal symptoms are associated with different serum testosterone thresholds in middle-aged and elderly men.

To determine the association between hypogonadal symptoms and total serum testosterone levels in middle-aged and elderly men (aged > 40 years), and to identify whether there exists a clear-cut discriminatory threshold of total testosterone below which the probability of hypogonadal symptoms increases. We retrospectively reviewed the charts of 360 men who presented to an outpatient men's health clinic with a chief complaint of low testosterone. Sexual, psychological, and physical symptoms were evaluated using the androgen deficiency in the aging male (ADAM) questionnaire. Serum levels of total testosterone were collected on the same day on which men completed their ADAM questionnaires. We performed the univariate (t test, chi-square, and binary logistic regression) and multivariate analyses (binary logistic regression) to evaluate the total testosterone threshold and the symptoms that predicted a low-testosterone level. A cluster of symptoms: 1 sexual (decreased libido), 1 psychological (decreased energy), and 3 physical (decreased strength or endurance, decreased ability to play sports, and falling asleep after dinner) were most associated with total serum testosterone levels of ≤ 300 ng/dL. The threshold testosterone serum levels that were associated with an increased prevalence of these hypogonadal symptoms ranged from 320 to 375 ng/dL. On multivariate analysis, age, but not symptoms on the ADAM questionnaire, predicted a total testosterone level of < 300 ng/dL. A distinct constellation of hypogonadal symptoms exists at various serum testosterone levels. Consequently, identification of the thresholds for specific symptom management will be critical in establishing patient-centered treatment algorithms.

Efficacy and safety of rosuvastatin in late-onset hypogonadism patients with dyslipidaemia

Rosuvastatin has been used for treatment of dyslipidaemia and metabolic syndrome, but the efficacy has not yet been tested in men with late-onset hypogonadism (LOH). To assess and compare the efficacy and safety of rosuvastatin in men with dyslipidaemia with LOH and non-LOH, a retrospective study was conducted in patients who received rosuvastatin 10mgday(-1) from the men's health clinic. The primary endpoint was the change in low-density lipoprotein (LDL)-cholesterol (C) after 24weeks of treatment. A total of 145 dyslipidaemic patients eligible for rosuvastatin treatment were enrolled and divided into LOH group (45.52%) and non-LOH (54.48%) group. There were favourable changes in the lipid profiles. In the LOH group whose serum testosterone had been raised by testosterone administration, the favourable changes of the lipids were of similar magnitude as in the non-LOH group. The percentage of patients reaching the target goal (LDL<100mgdL(-1) ) did not differ significantly between the group of non-LOH and LOH men treated with testosterone. Side effects were noted in 1/145 men. It is concluded that rosuvastatin was safe and effective in lowering low-density lipoprotein cholesterol in both non-LOH and LOH dyslipidaemic patients whose serum testosterone levels had normalised.

The effect of obesity and components of metabolic syndrome on urinary and sexual functions in Saudi men

ObjectiveTo establish a possible association between obesity, measured by waist circumference (WC) and body mass index (BMI), and voiding and sexual functions in a random cohort of Saudi men.Materials and methodsAn outpatient men’s health clinic was set up at King Abdulaziz University Hospital in Jeddah, Saudi Arabia and men were invited to discuss their sexual and urinary functions. The data collected included age, WC, weight, height, blood pressure, history of diabetes, hypertension, and smoking. The International Prostate Symptom Score (IPSS) and the International Inventory of Erectile Function (IIEF-5) questionnaire were used to assess urinary tract symptoms and sexual function, respectively. Serum testosterone, prostate-specific antigen and cholesterol levels were measured and documented. Data were analyzed using the Statistical Package for the Social Sciences.ResultsWe recruited 113 participants. The mean WC and BMI of the men were 104 ± 14.599 cm and 29.706 kg/m2, respectively. Thirty-seven men (32.7%) had an IPSS ≥ 8 points. Sexual disorders were reported in 19 men; 16 men had erectile dysfunction, while three had premature ejaculation. Of the whole cohort, 37 men were diabetic, of which 15 (40.5%) had an IPSS ≥ 8 and 13 (35%) were either overweight or obese.ConclusionIncreased WC and BMI were associated with diabetes mellitus and large percentages of voiding and sexual disorders.

The relationship between anogenital distance and age

In humans, recent studies have correlated anogenital distance (AGD) in adult men to intrinsic testicular function. Although rodent studies suggest that AGD is determined in utero and remains constant in adult life, it is not certain if AGD remains constant across a man's adult life. We sought to determine if adult male AGD varies based on age. A cross-sectional study of men being evaluated at a men's health clinic. Anogenital distance (the distance from the posterior aspect of the scrotum to the anal verge) and penile length (PL) were measured using digital callipers. anova and linear regression were used to determine correlations between AGD, fatherhood status and age. In all, 473 men were included in the analysis with a mean age of 43±13years. The mean AGD for the group was 39±13mm. Anogenital distance did not vary between age categories for the entire group, for fathers, and for childless men. Moreover, penile length also remained constant across age categories. On adjusted analyses stratified by fatherhood status, there was no relationship between AGDp and age. The current cross-sectional study demonstrates that anogenital distance, defined as the distance from the posterior scrotum to the anal verge, is similar for men of different ages. As such, AGD may provide a measure for genital development and function throughout adult life. However, confirmation with longitudinal studies is needed.

Sentinel Surveillance for Pharyngeal Chlamydia and Gonorrhea Among Men Who Have Sex With Men—San Francisco, 2010

Although a potentially important route for transmission, limited data exist on the burden of pharyngeal chlamydia (CT) and gonorrhea (GC) among men who have sex with men (MSM). We examined pharyngeal CT and GC among MSM screened in San Francisco in 2010. MSM seeking services in a variety of clinical settings provided clinician-collected pharyngeal specimens that were tested using the APTIMA Combo 2 platform. The prevalence of pharyngeal CT and GC was estimated at 5 sentinel sites: the municipal STD clinic, a gay men's health clinic, an HIV care clinic, an HIV testing site, and primary care clinics supported by the San Francisco Department of Public Health. Positivity for each infection was calculated as the number of positive tests divided by the number of testers with corresponding confidence intervals (CI). In 2010, a total of 12,454 pharyngeal CT specimens and 12,457 pharyngeal GC specimens were tested for an overall CT positivity of 1.69% (95% CI: 1.47-1.93) and GC positivity of 5.76% (95% CI: 5.36-6.19). At the 5 sentinel sites, pharyngeal CT positivity ranged from 1.10% (HIV testing site) to 2.28% (STD clinic); pharyngeal GC positivity ranged from 3.4% (HIV testing site) to 7.01% (STD clinic). Sentinel surveillance data indicate that there is a substantial burden of pharyngeal CT and GC infections among MSM in San Francisco. Identification and treatment of pharyngeal infections could prevent ongoing transmission of these bacteria. Increasing access to nucleic acid amplification tests-based pharyngeal screening should be a public health priority.

The relationship between anogenital distance and the efficacy of varicocele repair

Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? Anogenital distance (AGD) is a marker of genital development and adult testicular function. To date, there is no data on the clinical utility of using such an anthropomorphic variable. About 30% of men will have no improvement in semen parameters after varicocele repair. It is currently difficult to assess which patients are most likely to benefit from surgical repair. The present study showed that men with a longer AGD had a higher likelihood of improvement after varicocelectomy. As such, AGD may allow clinicians to better counsel men on the efficacy of varicocele repair. • To investigate whether anogenital distance (AGD) can identify men most likely to show improved semen parameters after varicocele ligation, as AGD has been shown to correlate with intrinsic adult testicular function. • Men with varicoceles who were evaluated at a men's reproductive health clinic in Houston were recruited. • AGD (the distance from the posterior aspect of the scrotum to the anal verge) was measured using digital callipers. • Logistic regression was used to compare outcomes after stratifying men based on AGD. • In all, 46 men with a mean (sd) age of 33.1 (6.3) years with postoperative semen data were recruited. • Semen concentration, motility, and total motile sperm count all showed significant improvement postoperatively (P < 0.01). • While 48% of men with a shorter AGD had improvements in sperm concentration postoperatively, 84% of men with a longer AGD improved (P = 0.01). • There was a trend toward a lower percentage of men (62% vs 84%) with shorter AGDs showing improvements in total motile sperm count (P = 0.09). • AGD may provide a novel metric to assess intrinsic testicular function and predict efficacy of varicocele repair.

Treatment with a Uroselective α1‐Blocker Improves Voiding and Sexual Function: A Study in Thai Men with Lower Urinary Tract Symptoms

Lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) negatively affect quality of life. The α1-blockers are effective for LUTS suggestive of benign prostatic hypertrophy. To analyze the effect of a uroselective α1-blocker on both voiding and sexual dysfunction in Thai men with LUTS. Of 488 men with LUTS who received 10 mg alfuzosin monotherapy once daily (OD) at a men's health clinic, 313 men (64%) completed 8 months of alfuzosin treatment and filled the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function (IIEF)-5 questionnaires. The relationships among the IPSS, IIEF-5 score, and select clinical characteristics were analyzed using multiple regression analysis. To identify changes from the baseline, the chi-square or Fisher's exact test was used for categorical or dichotomous variables and a paired Student's t-test was used for continuous variables. The 313 men were followed up for a mean (standard deviation [SD]) of 35.6 (2.2) weeks. LUTS were categorized by IPSS as moderate in 100 patients (31.9%) and severe in 213 patients (68.1%). ED was graded according to the IIEF-5 as normal in 46 patients (14.7%), mild in 29 patients (9.3%), mild to moderate in 81 patients (25.9%), moderate in 47 patients (15.0%), and severe in 110 patients (35.1%). ED is associated with LUTS (P=0.008). After 8 months of alfuzosin treatment, the mean (SD) IPSS and IIEF-5 score significantly improved from 19.95 (6.4) to 11.13 (4.6) (P<0.001) and from 11.5 (6.9) to 14.9 (5.7) (P<0.001), respectively. However, the IIEF-5 score did not improve significantly in patients with severe LUTS as determined using the IPSS. The most common adverse event with alfuzosin treatment was mild (dizziness, 2.2%). Treatment with 10 mg alfuzosin OD is safe and effective in improving voiding and sexual function in Thai men with LUTS and ED.