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PubMed2001

[The history of modern andrology].

The beginning of the history of modern Andrology as a clinical science can be located at the mid-century of 1900. The term itself of "Andrology" was first proposed in 1951. At that time, basic scientists coming from different cultural backgrounds - the main roots were urology, endocrinology and in some cases dermatology - "discovered" their common interest in the field of the male reproductive system, whose pathology and even physiology have been for a long time ignored or disregarded, often considered a shame more than a clinical entity. Very soon, many other specialists joined the team; among these biologists, genetics, psychologists etc., under, for the first time in history, the common definition of "Andrologists". They organized themselves in National and International Societies whose members, at the moment, are more than 8,000; holding national and international Meeting Workshops and Conventions all around the world and editing Textbooks and Journals. On the educational ground, pre - and post graduated courses are held in several Countries, both for medical students and doctors. Although a melting-pot of different cultural basis, today Andrology can be defined an unitary medical discipline dealing with the pathophysiology of the male reproductive system during all the life course of the male subject, from development to maturity and senescence. Shortly, and according to the WHO definition, it deals with male reproductive health. Quite similar to what is Gynecology for the female subject. The late arrival of the andrological discipline on the stage of modern medicine gave it the advantage of utilizing all the modern achievements of basic and clinical science, from molecular biology to ultrastructure, to genetic etc., reaching levels of high quality. Today, modern andrology, according to the principles of Evidence-Based Medicine, and although much is left to do, can effectively manage all the main pathologies of the male organism, form infertility to erectile dysfunction, but taking care of problems of puberty and senescence ("andropause") as well; giving to the male subject the "quality of life" that must be granted to every human being.

History, 20th Century↗
PubMedDate not supplied

Serum androgen bioactivity during 5alpha-dihydrotestosterone treatment in elderly men.

The androgens used in the treatment of age-related androgen decline have different bioactivities that cannot be evaluated with conventional detection methods for serum steroids. We have recently developed a recombinant cell bioassay for the determination of androgen bioactivity in human serum that is based on androgen-specific interaction between the ligand-binding domain (LBD) and the N-terminal region of the androgen receptor (AR). In this work, we examined the effect of topically applied 5alpha-dihydrotestosterone (DHT; 7.5-10 g of 2.5% DHT gel daily for 6 months) on circulating androgen bioactivity in 14 men (age range, 51-63 years) with symptoms of andropause and pretreatment serum testosterone less than 15 nM, or serum sex hormone-binding globulin concentration greater than 30 nM, or both. The mean (+/-SEM) pretreatment androgen bioactivity was 3.3 +/- 0.3 nM testosterone equivalents, and the levels correlated with serum testosterone concentration (r =.55, P <.05). DHT gel treatment induced a sixfold increase (from 1.5 +/- 0.1 nM to 9.0 +/- 0.7 nM) in mean serum DHT level, whereas endogenous testosterone and estradiol levels measured with radioimmunoassays were suppressed by approximately 70% and approximately 50%, respectively (P <.0001). Concomitantly, serum androgen bioactivity increased by sevenfold (from 3.3 +/- 0.3 to 23.6 +/- 2.8 nM testosterone equivalents; P <.0001). We conclude that DHT gel therapy in elderly men significantly increases their circulating androgen bioactivity as measured with a mammalian cell bioassay. An androgen-specific bioassay such as ours may enable investigation of other androgens with different bioactivities, such as selective AR modulators.

Aging↗
PubMed2003

[The challenge of male reproductive health].

Recently, research on male reproductive ability brings along the concern on male reproductive health. At present time, the situation of reproductive health was not optimistic and many problems need to be solved. In this article, many important topics were included, such as the changing and the possible reasons of male reproductive health; much concern was needed for babies, children, and male juvenile; increasing tendency of the infection rates of male urogenital system; research on male infertility needed to be explored deeply; there was no satisfactory methods for male contraception; the diagnosis and treatment of male erectile dysfunction were not sufficient for the need; research on andropause was at the primary stage; life regime of men needed to be adjusted. Concerning for male reproductive health is the responsibility of both medical workers and whole society.

Contraceptive Devices, Male↗
PubMed2003

Oral testosterone undecanoate (Andriol) supplement therapy improves the quality of life for men with testosterone deficiency.

In a single-blind, placebo-controlled study, the effects of a 3-month oral administration of 160 mg/day testosterone undecanoate (Andriol) on the quality of life of men with testosterone deficiency were evaluated. The subjects included ten men with primary hypogonadism and 29 with andropause with sexual dysfunction as the most common problem. The changes in subjective symptoms were evaluated by the PNUH QoL scoring system and the St. Louis University Questionnaire for androgen deficiency in aging males (ADAM). Digital rectal examination (DRE) was performed and serum testosterone, prostate-specific antigen (PSA) and liver profile were monitored. Testosterone undecanoate treatment (n = 33) significantly improved sexual dysfunction and symptom scores of metabolic, cardiopulmonary, musculoskeletal and gastrointestinal functions compared to baseline and to placebo (n = 6). ADAM score also significantly improved after 3 months of treatment. Serum testosterone was significantly increased compared to pretreatment levels only in the testosterone undecanoate group. In the placebo group, no significant changes compared to baseline were found for testosterone levels and QoL questionnaires. No abnormal findings were detected on DRE or laboratory findings in either group. Adverse events, such as gastrointestinal problems and fatigue, were mild and self-limiting. It is concluded that androgen supplement therapy with oral testosterone undecanoate (Andriol) restores the quality of life through improvement of general body functions in men with testosterone deficiency.

Administration, Oral↗
PubMed2003

[Investigation, treatment and monitoring of late-onset hypogonadism in males: the official guidelines of the International Society for the Study of the Study of the Aging Male (ISSAM) with comments].

There is increasing interest in the subject of hormone changes in the aging male, which is likely to become particularly important with the expected growth in the population of men over 50. The main concerns at present are androgen decline in the aging male (ADAM), or partial androgen deficiency of the aging male (PADAM), commonly known as the andropause. Although there have been advances in our knowledge of androgen deficiency in the aging male, it is still incomplete, sometimes confusing, and some aspects of androgen replacement therapy remain controversial. The International Society for the Study of the Aging Male (ISSAM) therefore felt it was a good time to review the current situation by publishing a series of practical and official guidelines concerning the diagnosis, treatment and monitoring of late-onset hypogonadism in males. The aim of this study is to present the French translation of these recent international guidelines, and to comment on them.

Aging↗
PubMed2003

[Male breast cancer].

Male breast cancer (MBC) is a rare disease, accounting for less than 1% of all breast cancers. It is an infrequent, but serious clinical problem. This paper discusses epidemiology, potential risk factors, tumor histopathology, clinical features and treatment strategies of the disease. Hormonal, genetic and environmental factors associated with an increased risk of breast cancer in men have been reviewed. Authors suggest that there may be an association between long-term androgen therapy and breast cancer in men. This uncommon malignancy is most commonly seen in men over sixty years. Histologically MBC resembles that seen in women, although lobular cancer is rare in men. Tumors from men are more often estrogen-receptor positive. Treatment strategies draw from experience in women and usually begin with surgery. Modified radical mastectomy is the current treatment of choice for invasive cancer. Additional modalities include hormonal treatment, radio- and chemotherapy. Male breast cancer may be also a problem in the context of androgen replacement therapy during andropause.

Androgens↗
PubMed2003

[Relationship between stroke and hormonal changes in various periods of life time].

Strokes are still considered a major social problem. The purpose of this paper is to discuss hormonal changes in various periods of life in the context of stroke occurrence. The influence of menopause and andropause on cerebrovascular diseases is described and the association between such conditions and osteoporosis is analyzed. Particular attention is paid to the incidence of strokes in pregnancy, as well as among women receiving oral contraceptives and replacement therapy.

Aged↗
PubMed1992

Neuroendocrinology of aging in the male and female.

Many changes in the neuroendocrine axis occur with healthy normal aging in humans. Women cease ovarian follicle maturation and menstrual cycles entering the estrogen-deficient state termed menopause. Although not without risk, estrogen and progesterone replacement in postmenopausal women has been shown to ameliorate the complications of lowered estradiol concentrations, such as hot flushes and osteoporsis, while improving the risk of cardiovascular complications. Aging men have lowered serum free and total testosterone concentrations and may experience a less well defined symptom complex termed andropause. Both signs and symptoms of thyroid disease and interpretation of thyroid function tests are difficult in aging humans. Specifically, TSH secretion is diminished in aging so that suppressed serum TSH concentrations are indicative of but not specific for hyperthyroidism. Cortisol secretion is not altered in aging, although serum concentrations of DHEA-S are lower. Prolactin concentrations are increased in both men and women, with the increase being more pronounced in men. The clinical significance of this increase has not yet been determined. Finally, elderly humans are more likely to develop difficulties with fluid and electrolyte balance. Although some alterations in AVP secretion have been shown in the elderly, plasma concentrations are similar in young and elderly subjects. Other mechanisms, such as decreased glomerular filtration rate and a decreased sensitivity of the thirst mechanism in response to hypertonicity, may be important contributors to fluid and electrolyte imbalances.

Aging↗
PubMed2004

[Investigation, treatment and surveillance of late-onset hypogonadism in males: the official guidelines of the International Society for the Study of the Aging Male (ISSAM) with comments].

There is growing interest in the hormonal changes of the ageing male, particularly in view of the expected growth of the population of males over the age of 50. Current research topics essentially concern androgen decline in the aging male (ADAM), or partial androgen deficiency of the aging male (PADAM), commonly called "andropause" in France. Although progress has been made in our knowledge concerning androgen deficiency of the aging male, it is still incomplete, sometimes confused, and some aspects of androgen replacement therapy remain controversial. The International Society for the Study of the Aging Male (ISSAM) therefore considered it appropriate to propose a series of practical and official guidelines concerning the investigation, treatment and surveillance of late-onset hypogonadism in males. The French translation of these recent international guidelines is presented and discussed in this article.

Age Factors↗
PubMed1992

Erectile dysfunction in Singapore men: presentation, diagnosis, treatment and results.

Three hundred and thirteen new cases were seen in more than two years at the Sexual Dysfunction Clinic at the Division of Urology, Toa Payoh Hospital (TPH). Patients were assessed by history, clinical examination, psychological evaluation, hormonal and biochemical tests; special investigations such as monitoring of nocturnal penile tumescence, cavernosography, selective pudendal arteriography and tests of neurological function were performed where indicated. Two hundred and twenty-seven patients (72.5%) had impotence due to organic causes while 86 patients (27.5%) were found to have psychogenic impotence. Diabetes mellitus and vascular disease account for the large proportion of organic impotence (81%). Patients with psychogenic impotence responded fairly well to psychosexual therapy and drug treatment in certain cases. Forty-four patients underwent medical therapy which consisted mainly of pharmacologically induced penile erections by the use of papaverine, phentolamine or prostaglandin E-1; 21 patients (48%) who were on self-injection therapy became non-compliant subsequently. One hundred and fourteen andropausal patients with low testosterone levels received hormonal replacement. Thirty-one patients underwent surgery--stripping and ligation of the deep dorsal vein of the penis (13 patients), microsurgical arterial revascularisation (two patients) and penile prosthetic implantation (16 patients). Our success rates for the operations were 54%, 100% and 88% respectively.

Adult↗
PubMedDate not supplied

Neologisms in medical practice: their potential to be 'useful', 'useless' or 'misleading'.

BACKGROUND: The advances in human endeavours have led to changes in technology. New words, neologisms, have been creeping up and are coined with astounding speed. While these terms are fascinating etymologically, their impact needs to be appreciated from a realistic perspective to keep one aware of the collateral changes we are importing into common language, particularly in medical practice. The aim of this paper is to identify some of such neologisms, outline their current use and then discuss their potential to be 'useful' 'useless' or 'misleading'. METHODS: Terminologies in medical practice and information technology have been selected by the authors and their meanings have been analysed. RESULTS: The terminologies of our present interest include: Computer literacy; Surfing the web; Networking; Information technology; Medical informatics; Telemedicine; Capacity building; Problem-based learning; Mentoring; Learning curve; Evidence-based medicine; Impression; Comorbid conditions; Family medicine; Andropause; Surgical site infection; Confidence interval. CONCLUSION: Neologisms are inescapable in the face of rapid advances in knowledge, equipment and information dissemination to and through diverse cultures and languages. In their assimilation, we should be considerate in discarding familiar terms that have served time.

Humans↗
PubMed2005

Somatopause: dismetabolic and bone effects.

The physiological changes that the human body undergoes during aging are similar to those observed in GH deficiency (GHD). Early changes of aging are represented by increased fat mass, increased cardiovascular risk, reduced muscle mass and strength, reduced exercise tolerance, thinned skin, decreased strength and impaired quality of life. These observations led to hypothesize that the elderly could be GH deficient and would benefit from GH treatment. However, the effects of GH treatment in healthy elderly subjects by randomized and controlled studies are less promising than initially hypothesized. The etiopathology of age-related bone loss is multifactorial including menopause, andropause, somatopause and secondary hyperparathyroidism. GH has multiple effects on bone, either direct or mediated by IGF-I, stimulating osteoblast proliferation as well as osteoclast differentiation. Consequently, decline in GH secretion reduces bone turnover that causes osteopenia in young adults, but it has been hypothesized that it could protect against fractures in elderly subjects. The increase of bone remodeling achieved by GH therapy may be helpful in elderly men and women who have severely decreased bone turnover and impaired osteoblastic function. In conclusion, the endocrine pattern of aging is distinct from the decrease of GH/IGF-I levels associated with hypopituitarism. However, GH plays a role in metabolism and bone physiology throughout the human life span, although there is insufficient evidence for a clear therapeutic role of rhGH in aging. Thus, more data are needed to define the effects of somatopause to identify who could potentially benefit from the effects of somatotropic treatment.

Adult↗
PubMed2003

Androgen replacement therapy in the aging male.

Beginning around age 40 years, men experience a decrease in testosterone level-referred to as "andropause"-and the pathophysiologic changes that accompany this decrease. Androgen replacement therapy, typically used for the treatment of senile hypogonadism, is evolving as a potential treatment of various other conditions related to testosterone loss, such as osteoporosis, sarcopenia, and even psychological symptoms. As with any treatment modality, certain patient factors are more predictive of success with minimal adverse effects, and consideration must be given to concomitant conditions. This article will provide a review of recent studies examining the effects of androgen supplementation and evaluate the purported benefits and potential risks of this therapy. Further research is anticipated to elucidate the most appropriate candidates, as well as other potential indications, for this treatment.

Journal Article↗
PubMed2004

Testosterone replacement therapy for a man with prostate cancer.

A 52-year-old male with elevated serum prostate-specific antigen (PSA) level, moderate lower urinary tract symptoms (LUTS), and negative family history of prostate cancer is found to have adenocarcinoma of the prostate with negative bone scan. Following radical retropubic prostatectomy and satisfactory postoperative recovery, heretofore undetectable serum PSA level rose 35 months later. Digital rectal examination (DRE) and bone scan were negative. Adjuvant external beam radiation preceded by a 3-month injection of goserelin was initiated. Radiation was well tolerated, although the patient reported significant loss of libido, hot flashes, and depression warranting antidepressant medication. Failure to respond to this intervention led to initiation of supplemental testosterone; 1 month later, the patient reported significant relief of symptoms. The patient is currently successfully tapering use of supplemental testosterone in order to decrease andropause symptoms and to permit restoration of intrinsic testosterone.

Case Reports↗
PubMed1993

[Changes in sexuality and fertility in the elderly: ejaculation].

After the remark of the own results on an epidemiological research about andropausal sexual problems, the Authors analyze the alterations of ejaculatory mechanism with elderly, focusing frequency and etiopathogenesis. They underline the need of prevention of ejaculatory disturbances deriving from chronic disease or of iatrogenic origin.

Aged↗
PubMed1993

The male climacterium.

In contrast to women, fertility in men persists until a very old age. However, testicular function of both the exo- and endocrine compartments decreases in old age, causing a series of clinical symptoms which are analogous to, although less pronounced than, the menopausal syndrome. These symptoms can be considered to represent the male climacterium or andropause. However, whereas at menopause ovarian hormonal secretion ceases almost completely, the decrease in the levels of biologically active endrogens (free testosterone) is only moderate and many elderly men have free androgen levels that would be considered normal for young men. Moreover, whereas many well-controlled studies have shown the benefit of hormonal replacement therapy, at least for symptomatic posmenopausal women, so far no well-controlled studies exist that prove a favourable risk/benefit balance of androgen substitution in elderly men. The major risk is the potentially stimulating effect of androgens in elderly men who frequently present with subclinical prostatic carcinoma. Therefore, the generalized use of androgen substitution in elderly men cannot, as yet, be recommended.

Aged↗
PubMed1997

[Hormonal control of sexual behavior in males and endocrinologic causes of sexual dysfunction].

The role of androgens in the male sex differentiation, in the genesis and preservation of the erectile function is summarized. In sex differentiation, testosterone acts on genitalia and central nervous system (CNS). In CNS sexual steroids exert a morphogenetic action during neuronal development. At the pubertal age, the increase of testosterone leads to the development of sex characteristics, the onset of libido and the beginning of the nocturnal spontaneous erectile function. Spontaneous erections are androgen-dependent, and they are impaired in androgen deficiency. Normal androgen levels lead to make voluntary erections. However, in the human species, cortical influences may greatly affect what could be possible to occur in relation to the hormonal situation. Endocrine causes of sexual dysfunction are responsible for about 20-25% of the total; among these primary and secondary hypogonadisms are the most frequent and they are to be managed with causal treatments and androgen replacement therapy. Therefore, androgen treatments are not useful in functional sex disorders and they may be at risk on prostatic tissue. Andropause is related to a progressive reduction of testicular function, principally due to vascular disorders, with low-normal androgen levels. On the basis of these observations it is underlined that in the human species the androgen presence is a necessary but not sufficient condition for a correct sex function.

Adult↗