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PubMed1996

An amplitude-specific divergence in the pulsatile mode of growth hormone (GH) secretion underlies the gender difference in mean GH concentrations in men and premenopausal women.

Although many studies have discerned higher serum GH concentrations in women than in men, based on measurements of single random blood samples or integrated 24-h means, the neuroendocrine mechanisms that underlie such gender differences have not been defined. Such mechanisms might entail an increase in GH-secretory burst frequency, amplitude, or duration, heightened interpulse basal GH release, or a prolonged half-life of GH. These mechanisms can be distinguished by deconvolution analysis of appropriate GH time series. Earlier studies employed RIA or IRMA with sensitivities of 0.1-0.5 microgram/L, which result in frequently undetectable serum GH concentrations. To address these limitations, we undertook blood sampling at 10-min intervals for 24 h and applied a high-sensitivity immunofluorometric assay of GH (sensitivity 0.0115 microgram/L). Multiparameter deconvolution analysis was used to estimate specific features of GH secretion, while simultaneously calculating the half-life of endogenous GH. Eleven men and 11 premenopausal women from the same community were studied. Discrete peak detection by Cluster was employed as a complementary half-life-independent technique to assign variations in serum GH into pulsatile and basal fractions over 24 h. Cluster revealed significantly higher mean serum GH concentrations over 24 h in women (0.78 +/- 0.08 microgram/L) compared with in men (0.27 +/- 0.03 microgram/L, P < 0.00005). Women exhibited significantly higher maximal serum GH concentration peak values than men (2.08 +/- 0.34 microgram/L in women, 0.67 +/- 0.11 microgram/L in men, P = 0.0008), which could be, in turn, attributed to a significantly increased incremental serum GH peak amplitude (1.85 +/- 0.33 microgram/L in women vs. 0.60 +/- 0.10 microgram/L in men, P = 0.0021) and a longer peak duration (114 +/- 8 min in women, 86 +/- 4 min in men, P = 0.008). The mean area under the serum GH concentration peak was significantly (3-fold) higher in women than in men (98 +/- 17 micrograms/L.min in women, 34 +/- 8 micrograms/L.min in men, P = 0.0046). Serum GH peak frequency was similar in women (9.7 +/- 0.8 peak/24 h) and men (10.7 +/- 1.1 peak/24 h, P = NS). The mechanisms underlying the increase in serum GH concentration pulse amplitude, duration, and area were investigated further by deconvolution analysis. Deconvolution analysis disclosed equivalent secretory pulse frequencies in women and men (13 +/- 0.9 bursts/day in women, 10.5 +/- 1.3 bursts/day in men,P = NS), and statistically indistinguishable mean interburst intervals of 106 +/- 8 min in women and 150 +/- 26 min in men (P = NS). GH-secretory burst mass was significantly higher in women by approximately 2.4-fold (P = 0.0013) compared with in men, which was attributed to a greater burst amplitude. Only low levels of basal GH release were inferred in women (5%) and men (9%), which did not differ significantly between genders. Moreover, the calculated half-life of endogenous GH was no different in women compared with in men: 15.8 +/- 0.7 min vs. 17.1 +/- 0.8 min, respectively (P = NS). The calculated daily secretion rate was 3-fold higher in women (47 +/- 4.8 micrograms/L.24 h) than in men (15 +/- 1.8 micrograms/L.24 h) (P < 0.001). In summary, discrete peak-detection analysis of serum GH concentration profiles collected at 10-min intervals over 24 h in men and premenopausal women discloses significantly different mean serum GH concentrations that are accounted for by higher maximal and incremental serum GH peak amplitudes. Deconvolution analysis demonstrated that the mechanism supporting the amplitude-specific difference in women was an augmentation of the GH-secretory burst mass caused by a higher GH-secretory burst amplitude. These gender differences were highly specific because the frequency of detectable GH-secretory bursts, the calculated endogenous half-life, and the estimated basal GH release were no different in women than in men.

Adolescent↗
PubMed2005

[Total antioxidant capacity of seminal plasma in fertile and infertile men].

OBJECTIVE: To evaluate total antioxidant capacity (TAC) of seminal plasma in fertile and infertile men and understand the relation between seminal plasma TAC and male fertility. METHODS: Two hundred and twenty-five infertile men were divided into 10 cases of obstructive azoospermic men, 42 cases of non-obstructive azoospermic men,20 cases of oligozoospermic men, 78 cases of asthenozoospermic men, 57 cases of oligoasthenozoospermic men, and 18 cases of normozoospermic men, then 28 fertile men were taken as the control. The seminal parameter analysis was performed by computer-assisted semen analysis (CASA) system. Seminal plasma TAC was measured using spectroscopic analysis. RESULTS: Seminal plasma TAC were (1.71 +/- 1.33) U in obstructive azoospermic men, (12.73 +/- 9.44) U in non-obstructive azoospermic men, (10.85 +/- 6.64) U in oligozoospermic men, (13.88 +/- 8.24) U in asthenozoospermic men, (11.20 +/- 7.02) U in oligoasthenozoospermic men, (18.07 +/- 8.73) U in normozoospermic men, and (19.82 +/- 6.33) U in fertile men. There was no significant difference in TAC between normozoospermic men and fertile men (P > 0.05). Compared with fertile men, seminal plasma TAC in other infertile groups was significantly lower (P < 0.01). There were significantly made positive correlation between seminal plasma TAC and sperm density (r = 0.182, P < 0.05), as well as sperm with grade a (r = 0.150, P < 0.05). CONCLUSION: Seminal plasma TAC is closely related to male fertility, and the decreased level of TAC in seminal plasma may be one of the causes of male infertility.

Adult↗
PubMed1994

Prostate volume in testosterone-treated and untreated hypogonadal men in comparison to age-matched normal controls.

OBJECTIVE: The potential use of testosterone preparations for substitution therapy for ageing men and for male contraception, in addition to the well established substitution therapy of male hypogonadism, make increased testosterone use likely. However, little clinical information is available on the effect of testosterone therapy on the prostate in hypogonadal men. DESIGN AND MEASUREMENTS: In a controlled cross-sectional study, prostate volume measured by transrectal ultrasonography, serum levels of prostate-specific antigen (PSA) and sex hormones, and uroflow parameters were determined. PATIENTS: Three groups of age-matched men were enrolled in the study: 47 newly diagnosed hypogonadal men before testosterone treatment, 78 hypogonadal men with at least 6 months of effective testosterone therapy and 75 normal men. RESULTS: Regression analysis revealed a significant positive correlation of prostate volume with age in normal men and testosterone-treated hypogonadal men, whereas no significant correlation was detected in untreated hypogonadal men. Prostate volume was significantly lower in untreated hypogonadal men (12.2 (11.0-13.5) ml) (mean (95% confidence limits)) compared to both other groups. However, no significant difference in prostate volume was detected between testosterone-treated hypogonadal men (21.3 (19.9-22.8) ml) and normal men (22.9 (21.4-24.4) ml). Similar results were obtained for PSA with comparable values in the testosterone-treated hypogonadal men (0.98 (0.88-1.10) micrograms/l) and normal men (1.02(0.91-1.14) micrograms/l), and significantly lower concentrations in the untreated hypogonadal men (0.64 (0.55-0.73) micrograms/l). No differences in uroflow parameters were detected between the three study groups. CONCLUSIONS: Effective testosterone treatment of hypogonadal men results in prostate volume and prostate-specific antigen levels comparable to age-matched normal men. Therefore, testosterone-induced prostate growth should not preclude hypogonadal men from testosterone substitution therapy.

Adult↗
PubMed2005

How has the sexual behaviour of gay men changed since the onset of AIDS: 1986-2003.

OBJECTIVE: To report changes in sexual behaviour among gay men in Sydney from 1986 to 2003. METHODS: Baseline data from four studies of gay men in Sydney were used: the Social Aspects of the Prevention of AIDS study (1986/87: 91 HIV-positive and 444 HIV-negative men); the Sydney Men and Sexual Health cohort (1993-95: 237 HIV-positive and 910 HIV-negative men); the Health in Men cohort of HIV-negative gay men (2001-03: 1,148 men); the Positive Health cohort of HIV-positive gay men (2001/02: 237 men). Each sample was recruited and interviewed using similar methods. RESULTS: Fewer HIV-positive men had sex with casual partners over time (76.9% in 1986/87 to 63.7% in 2001/02; p = 0.001), but more HIV-negative men had sex with 10 or more casual partners in the previous six months (27.7% in 1986/87 to 37.7% in 2001-03; p = 0.012). The proportions engaging in particular sex practices with casual partners changed over time: anal intercourse without condoms that included ejaculation in the rectum fell from 29.4% among HIV-positive men and 32.4% among other men in 1986/87 to 17.8% and 10.0% respectively in 1993-95 (p = 0.034 and p < 0.001 respectively), but increased to 37.7% and 18.4% respectively in 2001-03 (p-values < 0.001); rimming one's partner increased from 36.8% among HIV-positive men and 17.6% among other men in 1986/87 to 63.6% and 52.3% respectively in 2001-03 (p = 0.001 and p < 0.001 respectively). CONCLUSION: Gay men's sexual behaviour with casual partners has changed over time, perhaps partly in response to HIV and partly as a general expansion of sexual repertoires. These changes have implications for gay men's health.

Adult↗
PubMed2006

The association between obesity and the diagnosis of androgen deficiency in symptomatic ageing men.

OBJECTIVE: To determine the influence of obesity on the diagnosis of age-related androgen deficiency (AD) in symptomatic men according to current Australian guidelines. DESIGN, SETTING AND PARTICIPANTS: A community-based cohort of healthy ageing men with symptoms suggestive of AD was studied between May 2001 and February 2003. Men were classified as obese or non-obese according to body mass index (BMI) or waist circumference (WC). MAIN OUTCOME MEASURE: Diagnosis of AD according to Endocrine Society of Australia (ESA) guidelines. RESULTS: 223 men aged 54-86 years with mean BMI 27.3 +/- 0.2 kg/m2 (range 20.5-36.2 kg/m2) were recruited; 99 men were obese (BMI > or = 30.0 kg/m2 or WC > or = 102 cm) and 124 men were non-obese. Obese men had lower total testosterone (TT) (12.7 +/- 0.4 v 15.0 +/- 0.4 nmol/L); P < 0.001) and calculated free testosterone (275.7 +/- 7.8 v 299.3 +/- 7.4 pmol/L); P = 0.03) levels than non-obese men. TT levels < 8 nmol/L were recorded in 12% of obese men and 1% of non-obese men. Applying the ESA guidelines for the diagnosis of age-related AD, 15 obese men (15%) and 4 non-obese men (3%) were classified as being eligible for androgen therapy supported by the Pharmaceutical Benefits Scheme (PBS); the relative risk in obese men was 1.92 (95% CI, 1.44-2.55; P < 0.001). CONCLUSION: Obesity is an important determinant of serum TT levels in ageing men. Almost one in seven obese men but only one in 30 non-obese men in our study were eligible for PBS-supported androgen therapy according to Australian guidelines. Although obese men are more likely to have biochemical hypoandrogenism, the clinical implications of this remain uncertain. Studies of testosterone therapy in this group of ageing men are needed to determine whether androgen replacement is beneficial.

Aged↗
PubMed1995

Severe osteoporosis in men.

OBJECTIVE: To evaluate men with severe osteoporosis for pathogenetic factors and to review the reported features of primary osteoporosis in men. DESIGN: Case series and clinical review. PATIENTS: 47 men consecutively referred to a metabolic bone center because of atraumatic (or minimally traumatic) fractures (91%) or radiographic osteopenia (9%). MEASUREMENTS: Clinical assessment, radiographs, chemical analyses of serum and urine, hormone assays, skeletal densitometry, and histomorphometry of iliac crest biopsy specimens. RESULTS: 27 of the 47 men (57%) had vertebral fractures, and 16 (34%) had appendicular fractures. Causal factors identified in 30 men (64%) included glucocorticosteroid treatment (8 men); hypogonadism (7 men); excessive alcohol consumption (7 men); and anticonvulsant use, osteomalacia, severe hyperthyroidism, or bone marrow neoplasia (8 men). Seventeen men (36%) had no medical conditions or known risk factors associated with bone disease. Spinal mineral density was well below the mean value for healthy young men in 94% of the patients with primary osteoporosis tested. Examination of biopsy specimens from 13 of 17 men with primary osteoporosis showed reduced trabecular bone volumes, normal bone formation rates, and slightly increased resorption surfaces. Fasting hypercalciuria was seen in some men (41%). In the primary osteoporosis group, eight men were followed serially (range of follow-up, 6 months to 9 years) while they were receiving a nonpharmacologic regimen (diet and activity); the mean axial bone mineral density of these men increased slightly. CONCLUSIONS: A thorough evaluation for identifiable causes of severe osteoporosis in men is warranted because definable pathogenetic factors are seen in many cases. A few men with severe osteoporosis have primary or idiopathic osteoporosis. Primary osteoporosis in men is probably caused by many factors because heterogeneous clinical, laboratory, and histologic features were seen in our series and in those of others. Further studies of primary osteoporosis are needed to define the course of the disease, to identify pathogenetic mechanisms, and to develop therapeutic interventions.

Adult↗
PubMed2004

Broadband ultrasound attenuation (BUA) of the heel bone and its correlates in men and women in the EPIC-Norfolk cohort: a cross-sectional population-based study.

Osteoporotic fractures have substantial clinical and public health impact. Bone quality is an important determinant of fracture risk. Quantitative ultrasound (QUS) of bone measured as broadband ultrasound attenuation (BUA) has been shown to predict fracture risk. However, there have been very few large population studies, particularly in men. We investigated the correlates of calcaneal BUA using a CUBA clinical machine in 15,668 middle and older aged men and women (42-82 years) from the UK, EPIC-Norfolk cohort. At all ages mean BUA was significantly greater in men than women (men, 90.1+/-17.6; women 72.1+/-16.5). The age-related decline in BUA was five times greater in women than men (-0.77 vs. -0.15 dB/MHz per year). Pre- and post-menopausal bone loss was 0.39 and 0.85 dB/MHz per year, respectively. In univariate regression BUA increased with weight and height by 0.45 dB/MHz per kg and 0.68 per cm in women and 0.24 dB/MHz per kg and 0.33 per cm in men. BUA increased with body mass index (BMI) by 0.84 dB/MHz per kg/m2 in women and 0.55 in men. However, weight was twice as influential as height in men and seven times as great in women. Age, weight and height explained 27% of the variance of BUA in women, but only 3% in men. Adjusted BUA was significantly lower in men and women with an existing history of any hip, wrist or spinal fracture both overall and when analysed for specific site. Figures were: all fractures 66.8 vs. 72.5 dB/MHz ( P<0.001), women; 84.1 vs. 90.5 ( P<0.001), men; hip fractures 61.9 vs. 72.2 dB/MHz ( P<0.001), women; 81.5 vs. 90.2 ( P<0.001), men; wrist fractures 66.6 vs. 72.5 dB/MHz ( P<0.001), women; 81.5 vs. 90.2 ( P<0.001), men; spinal fractures 68.1 vs. 72.1 dB/MHz ( P<0.01), women; 85.1 vs. 90.2 ( P<0.01), men. These differences equate to reductions of 14, 9 and 6% and 10, 7 and 6% for fractures of the hip, wrist and spine in the BUA of women and men, respectively. Thus, despite the overall gender difference in BUA the relative magnitude of a previous history of fracture was equally important in both men and women. Adjusted BUA was also lower in those with previous history of osteoporosis. In women currently taking hormone replacement therapy (HRT) the adjusted BUA was 5 dB/MHz or one-third of an SD greater than in those who did not. The BUA of those with a current smoking habit was 1.7% lower in women and 3.2% lower in men. Overall, there are substantial sex differences in the relationship of the physical and osteoporotic risk factors associated with BUA. A better understanding of these determinants of heel ultrasound may provide insights into how some of the sex differences in bone health can be explained and bone loss in later life minimised.

Adult↗
PubMed1986

Spectrum of rectal biopsy abnormalities in homosexual men with intestinal symptoms.

Homosexually active men have frequent intestinal and rectal symptoms resulting from sexually acquired gastrointestinal infections. We evaluated the histologic findings in rectal biopsy specimens obtained from 89 homosexual men with intestinal symptoms and 11 homosexual men without intestinal symptoms. All had undergone comprehensive microbiologic evaluation for rectal and enteric pathogens. Rectal biopsy specimens were evaluated without knowledge of clinical or microbiologic data by a standardized method for the presence or absence of abnormal histologic features. Forty-six percent of specimens from symptomatic men and 27% of those from asymptomatic men were abnormal. Acute inflammation was the most frequent histologic abnormality and was more frequent in men who had pathogens (51%) than men without pathogens (24%, p less than 0.02). Acute but not chronic inflammation was seen also in specimens from homosexual men without intestinal symptoms. Intestinal spirochetosis was present in specimens from 23 (26%) of the symptomatic and 5 (45%) of the asymptomatic men. In 5 of the 89 symptomatic men, biopsy features of idiopathic inflammatory bowel disease (IIBD) were present; all 5 of these men were infected with either Treponema pallidum or Chlamydia trachomatis. Features of IIBD were present in 25% of those infected with C. trachomatis or T. pallidum. Chronic inflammation was more frequent in men infected with C. trachomatis, syphilis, or herpes simplex virus type II: 31% vs. 3%, p = 0.0002. Acute inflammation was present in specimens from men with proctitis or proctocolitis and enteritis as well as in those from asymptomatic men, whereas chronic inflammation was present only in specimens from men with proctitis or proctocolitis. Both acute and chronic inflammation were more frequent when biopsy specimens of the abnormal mucosa were examined. When specimens from men with single infections were analyzed, histology was rarely diagnostic. We conclude that acute inflammation is frequent in rectal biopsy specimens from symptomatic and asymptomatic homosexual men; chronic inflammation is infrequent, but when present is significantly associated with syphilis, herpes simplex virus type II, and C. trachomatis infection.

Adult↗
PubMed2003

Long-term cancer control of radical prostatectomy in men younger than 50 years of age: update 2003.

OBJECTIVES: To compare the cancer control in men younger than 50 years with that in older men treated with radical retropubic prostatectomy (RRP) for localized prostate cancer in a contemporary series. In the 1970s and 1980s, men younger than 50 years old represented approximately 1% of newly diagnosed prostate cancer cases. However, with the widespread use of serum prostate-specific antigen (PSA) testing and increased public awareness of prostate cancer, this figure has risen (3.7% to 4%). Previous studies, mostly carried out before the PSA era, reported conflicting data with respect to cancer control for these younger men treated with RRP. METHODS: We analyzed the data from 2897 men who underwent RRP between April 1982 and September 2001. Preoperative PSA level, clinical and pathologic stage, and biochemical recurrence were compared between 341 men younger than 50 years old and 2556 men 50 years old or older. Disease-free (PSA less than 0.2 ng/mL) survival rates were compared using Kaplan-Meier analysis. Pathologic staging was compared using logistic regression analysis. RESULTS: Men younger than 50 years old had pathologic variables and 5, 10, and 15-year biochemical disease-free survival rates comparable to men aged 50 to 59 years (88%, 81%, and 69% versus 87%, 78%, and 71%, respectively). However, younger men had a lower incidence of extraprostatic extension (25% versus 31%; P <0.02), seminal vesicle involvement (2% versus 6%; P <0.03), and positive surgical margins (3% versus 9%; P <0.03), a greater organ-confined disease rate (65% versus 49%; P <0.0001), and a trend toward greater 5, 10, and 15-year biochemical disease-free survival rates, which did not reach statistical significance, compared with men aged 60 to 69 years (84%, 74%, and 67%, respectively; P <0.09). Furthermore, younger men not only had a lower rate of extraprostatic extension (25% versus 36%; P <0.001), seminal vesicle involvement (2% versus 10%; P <0.001), and positive surgical margins (3% versus 9%; P <0.001) and a greater organ-confined disease rate (65% versus 36%; P <0.0001), they also demonstrated significantly (P <0.003) greater 5, 10, and 15-year biochemical disease-free survival rates compared with men aged 70 years or older (72%, 58%, and 58%, respectively). CONCLUSIONS: Men diagnosed with prostate cancer who are younger than 50 years of age and are candidates for RRP tend to have a greater probability of organ-confined disease than older men. Younger men also demonstrate greater long-term cancer control rates than older men.

Adenocarcinoma↗
PubMed1998

MEN 11420 (Nepadutant), a novel glycosylated bicyclic peptide tachykinin NK2 receptor antagonist.

1. The pharmacological profile was studied of MEN 11420, or cyclo[[Asn(beta-D-GlcNAc)-Asp-Trp-Phe-Dap-Leu]cyclo(2beta-5beta )], a glycosylated derivative of the potent, selective, conformationally-constrained tachykinin NK2 receptor antagonist MEN 10627 (cyclo(Met-Asp-Trp-Phe-Dap-Leu)cyclo(2beta-5beta)). 2. MEN 11420 competitively bound with high affinity to the human NK2 receptor stably transfected in CHO cells, displacing radiolabelled [125I]-neurokinin A and [3H]-SR 48968 with Ki values of 2.5+/-0.7 nM (n = 6) and 2.6+/-0.4 nM (n = 3), respectively. 3. MEN 11420 showed negligible binding affinity (pIC50 < 6) at 50 different receptors (including tachykinin NK1 and NK3 receptors) and ion channels. 4. In the rabbit isolated pulmonary artery and rat urinary bladder MEN 11420 potently and competitively antagonized tachykinin NK2 receptor-mediated contractions (pK(B) = 8.6+/-0.07, n = 10, and 9.0+/-0.04, n = 12; Schild plot slope = -1.06 (95% c.l. = -1.3; -0.8) and -1.17 (95% c.l. = -1.3; -1.0), respectively). MEN 11420 produced an insurmountable antagonism at NK2 receptors in the hamster trachea and mouse urinary bladder. However, in both preparations, the effect of MEN 11420 was reverted by washout and an apparent pK(B) of 10.2+/-0.14, n = 9, and 9.8+/-0.15, n = 9, was calculated in the hamster trachea and mouse urinary bladder, respectively. 5. MEN 11420 showed low affinity (pK(B) < 6) at guinea-pig and rat tachykinin NK1 (guinea-pig ileum and rat urinary bladder) and NK3 (guinea-pig ileum and rat portal vein) receptors. On the whole, the affinities (potency and selectivity) showed by MEN 11420 for different tachykinin receptors, measured either in binding or in functional bioassays, were similar to those shown by the parent compound, MEN 10627. 6. The in vivo antagonism of the contractions produced by [betaAla8]neurokinin A(4-10) (1 nmol kg(-1)) was observed after intravenous (dose range: 1-10 nmol kg(-1)), intranasal (3-10 nmol kg(-1)), intrarectal (30-100 nmol kg(-1)) and intraduodenal (100-300 nmol kg(-1)) administration of MEN 11420. MEN 11420 was more potent (about 10 fold) and longer lasting than its parent compound MEN 10627, possibly due to a greater metabolic stability. 7. A dose of MEN 11420 (100 nmol kg(-1), i.v.), that produced potent and long lasting inhibition of the contraction of the rat urinary bladder induced by challenge with the NK2 selective receptor agonist [betaAla8]neurokinin A(4-10) (10-300 nmol kg(-1)), was without effect on the responses produced by the NK1 receptor selective agonist [Sar9]substance P sulphone (1-10 nmol kg(-1)). 8. These findings indicate that MEN 11420 is a potent and selective tachykinin NK2 receptor antagonist. The introduction of a sugar moiety did not produce major changes in the affinity profile of this antagonist as compared to MEN 10627, but markedly improved its in vivo potency and duration of action. With these characteristics, MEN 11420 is a suitable candidate for studying the pathophysiological significance of tachykinin NK2 receptors in humans.

Animals↗
PubMed2002

Cautious caregivers: gender stereotypes and the sexualization of men nurses' touch.

AIM: The aim of this research was to explore the experience of men nurses and the ways in which gender relations structure different work experiences for women and men in the same profession. BACKGROUND: Men are now entering the nursing profession in record numbers and challenging the notion that men are inappropriate in caregiver roles or incapable of providing compassionate and sensitive care. A limitation of the current state of knowledge regarding caring and men nurses is that it is primarily focused on men nursing students, not practising nurses. Little is known about men nurses' practices of caring and how such practices reflect the gendered nature of nursing and nurses' caring work. METHODS: The theme of men nurses as cautious caregivers emerged from data that were collected in two rounds of semi-structured interviews with eight men nurses practising in Nova Scotia, Canada. Thematic analysis, informed by feminist theory and masculinity theory, was used as the method for analysing the data. FINDINGS: For men nurses, the stereotype of men as sexual aggressors is compounded by the stereotype that men nurses are gay. These stereotypes sexualize men nurses' touch and create complex and contradictory situations of acceptance, rejection and suspicion of men as nurturers and caregivers. They also situate men nurses in highly stigmatized roles in which they are subject to accusations of inappropriate behaviour. For men nurses, this situation is lived as a heightened sense of vulnerability and the continual need to be cautious while touching and caring for patients. Ultimately, this situation impacts on the ability of men nurses to do the caring work they came into nursing to do.

Adult↗
PubMed2003

Comparison of the predictive accuracy of serum prostate specific antigen levels and prostate specific antigen density in the detection of prostate cancer in Hispanic-American and white men.

PURPOSE: The Hispanic-American population is the fastest growing in the United States. Although many studies have looked at the performance of prostate specific antigen (PSA) in the detection of prostate cancer in white and black men, few have looked at it in relation to Hispanic men. The objective of this study was to compare the performance of PSA and PSA density (PSAD) in the detection of prostate cancer in Hispanic and white men. MATERIALS AND METHODS: A total of 404 consecutive Hispanic and 341 consecutive white men with elevated serum PSA and/or abnormal digital rectal examination underwent transrectal ultrasound with lesion directed and systematic peripheral zone biopsies from 1996 to 2001 at a single institution by 2 investigators (ETG, MCB). Before biopsy all patients underwent volume measurements of the entire prostate. Of these patients 242 Hispanic and 255 white men had a total PSA between 2.5 and 10 ng/ml. Serum PSA and calculated PSAD were compared between the positive and negative biopsy groups, and between Hispanic and white men. RESULTS: Of the 242 Hispanic and 255 white men 85 (35.1%) and 63 (24.7%) had cancer, respectively (p = 0.0147). There was no significant difference in age among the groups. There was no significant difference in median PSA between Hispanic and white men, or white men with malignant versus benign disease. There was a significant difference in median PSA in Hispanic men with malignant versus benign disease (6.3 vs 5.2 ng/ml, p = 0.0072). For PSAD there was a significant difference between Hispanic men with malignant versus benign disease (0.17 vs 0.12, p <0.0001) and white men with malignant versus benign disease (0.13 vs 0.11, p = 0.0019). Overall there was a difference in PSAD between positive and negative biopsy groups, and there was a significant difference in PSAD between Hispanic and white men (0.13 vs 0.11, p <0.0001). CONCLUSIONS: This study shows for the first time that at similar levels of total PSA, PSAD is higher in Hispanic than in white men. Furthermore, these data show that while PSA was able to discriminate between malignant versus benign disease in Hispanic men, it was not able to do so in white men. Given the large number of patients in this series perhaps different PSAD cutoffs need to be defined for Hispanic men. Further study in this area is warranted.

Aged↗
PubMed1988

Special antigens on sperm from autoimmune infertile men.

Sera from three fertile men and four infertile men without sperm antibodies, 17 infertile men with sperm antibodies in serum and seminal plasma (S.P.), and 25 infertile men with sperm antibodies in S.P. were tested by Western Blot analysis against sperm membrane extracts and S.P. from fertile nonautoimmune men and infertile autoimmune men. Sera from fertile men reacted against common antigens with molecular weights (MW) of 28, 38, 48, 60, and 68 kD present on sperm from autoimmune and nonautoimmune men and special antigen of MW 76 kD on the sperm of fertile men. Sera from 15 of 17 (88%) autoimmune infertile men with sperm antibodies in serum and S.P. detected special antigens with MW of 58 kD (sera reactivity in 47% of these men), 43kD (in 29%), 30 kD (in 24%), 35 kD (in 18%), 52 kD (in 12%), 41 kD (in 6%), and 71 kD (in 6%) on the sperm of autoimmune men in addition to the common antigens. Sera from 15 of 25 (60%) men with sperm antibodies in their S.P. showed reactivity to special antigens with MW 52 kD (in 20%), 35 kD (in 16%), 41 kD (in 16%), 58 kD (in 8%), 70/71 kD (in 8%), 30 kD (in 8%), and 56 kD (in 4%). Sera from 18 of 42 (43%) infertile men with sperm antibodies also detected special antigens of MW 26, 46, and 76 kD present only in fertile men's sperm. Sera from only 15 of 42 (36%) autoimmune infertile men reacted against special antigens with MW 17, 20, 23, 30, 43, and 58 kD in the seminal plasma of autoimmune infertile men.(ABSTRACT TRUNCATED AT 250 WORDS)

Antigens↗
PubMed1993

Clinical presentation of genital warts among circumcised and uncircumcised heterosexual men attending an urban STD clinic.

INTRODUCTION: A recent study comparing heterosexual men with and without confirmed sexually transmitted diseases (STDs) in an urban STD clinic showed that uncircumcised men were less likely than circumcised men to have genital warts detectable by clinical examination (adjusted odds ratio 0.7, 95% confidence interval 0.4, 0.9). Based on these initial findings we hypothesised that the appearance and anatomic distribution of genital warts, and possibly treatment response, may be different for circumcised and uncircumcised men. METHODS: The anatomic location, appearance, number of warts, and response to treatment was investigated through review of medical records of 459 heterosexual men with genital warts detected in 1988. RESULTS: Age- and race-adjusted estimates indicated that among men with genital warts, warts were detected much more commonly on the distal penis--that is, the corona, frenulum, glans or urethral meatus-, among uncircumcised men (26%) than among circumcised men (3%) (OR 10.0, 95% CI 3.9, 25.7). Where the appearance was specified, warts were more often described as condylomatous in uncircumcised men and slightly more often as papular in circumcised men. No significant difference between circumcised and uncircumcised men was seen in the number of return visits to the clinic for persistent warts after treatment with liquid nitrogen: 2.2 visits for 19 uncircumcised men and 2.3 visits for 149 circumcised men. CONCLUSION: Circumcised men were more likely than uncircumcised men to have genital warts, but when present, warts were more often located on the distal portion of the penis among uncircumcised men. This paradox is not understood, but could reflect either nonspecific resistance to proximal penile warts conferred by the foreskin, or heightened susceptibility to various HPV types in uncircumcised men, some of which may confer subsequent immunity to genital warts.

Adolescent↗
PubMed1999

Semen quality and reproductive hormones before orchiectomy in men with testicular cancer.

PURPOSE: To obtain information about preorchiectomy gonadal function in patients with testicular germ cell cancer to improve the clinical management of fertility and other andrologic aspects in these men. PATIENTS AND METHODS: In group 1, a group of 83 consecutive patients with testicular germ cell cancer (TGCC) investigated before orchiectomy, semen analysis was carried out in 63 patients and hormonal investigations, including measurement of follicle-stimulating hormone, luteinizing hormone (LH), testosterone, estradiol, sex hormone-binding globulin (SHBG), inhibin B, and human chorionic gonadotropin (hCG), in 71 patients. Hormone levels in patients with elevated hCG (n = 41) were analyzed separately. To discriminate between general cancer effects and specific effects associated with TGCC, the same analyses were carried out in a group of 45 consecutive male patients with malignant lymphoma (group 2). Group 3 comprised 141 men employed in a Danish company who served as controls in the comparison of semen parameters. As a control group in hormone investigations, 193 men were selected randomly from the Danish National Personal Register to make up group 4. RESULTS: We found significantly lower sperm concentration (median, 15 x 10(6)/mL; range, 0 to 128 x 10(6)/mL) and total sperm count (median, 29 x 10(6)/mL; range, 0 to 589 x 10(6)) in patients with testicular cancer than in patients with malignant lymphomas (sperm concentration: median, 48 x 10(6)/mL; range, 0.04 to 250 x 10(6)/mL; sperm count: median, 146 x 10(6); range, 0.05 to 418 x 10(6)) (P < .001 and P < .001) and healthy men (sperm concentration: median, 48 x 10(6)/mL; range, 0 to 402 x 10(6)/mL; sperm count: median, 162 x 10(6); range, 0 to 1253 x 10(6)) (P < .001 and P < .001). FSH levels were increased in men with testicular cancer (median, 5.7 IU/L; range, 2.0 to 27 IU/L) compared with both men with malignant lymphomas (median, 3.3 IU/L; range, 1.01 to 12.0 IU/L) and healthy controls (median, 4.1 IU/L; range, 1.04 to 21 IU/L)(P = .001 and P = .007, respectively). Surprisingly, we found significantly lower LH in the group of men with TGCC (median, 3.6 IU/L; range, 1.12 to 11.9 IU/L) than in healthy men (median, 4.7 IU/L; range, 1.3 to 11.9 IU/L) (P = .01). We could not detect any differences between men with testicular cancer and men with malignant lymphomas and healthy men with regard to serum levels of testosterone, SHBG, and estradiol. Men with testicular cancer who had increased hCG levels had significantly lower LH and significantly higher testosterone and estradiol than those without detectable hCG levels. CONCLUSION: Spermatogenesis is already impaired in men with testicular cancer before orchiectomy. Neither local suppression of spermatogenesis by tumor pressure nor a general cancer effect seems to fully explain this impairment. The most likely explanation is preexisting impairment of spermatogenesis in the contralateral testis in men with testicular cancer. The question of whether also a pre-existing Leydig cell dysfunction is present in men with testicular cancer could not be answered in this study because the tumor seems to have a direct effect on the Leydig cells. Men with testicular cancer had low LH values as compared with controls. We speculate that increased intratesticular level of hCG also in men without measurable serum hCG may play a role by exerting LH-like effects on the Leydig cells, causing increased testosterone and estrogen levels and low LH values in the blood.

Adult↗
PubMed1987

Variable androgen receptor levels in infertile men.

Labeled methyltrienelone was used to determine androgen receptor (AR) levels in cultured pubic skin fibroblasts in 40 infertile men with primary seminiferous tubule disorders and 18 normal men. LH pulse patterns and mean serum LH levels were also determined by blood sampling at 10-min intervals for 6 h. The infertile men and the normal men had similar mean receptor levels [mean, 28.1 +/- 2.0 (+/- SEM) and 24.8 +/- 1.8 fmol/mg protein, respectively]. However, 5 men with chromosomal disorders had a higher mean AR level (41.3 +/- 6.2 fmol/mg protein) than the normal men, and 5 of the remaining infertile men (14.2%) had receptor levels that were less than the minimum value in normal men. In men with idiopathic oligospermia, 19.0% had low receptor levels. Although mean serum FSH and testosterone levels were similar in the infertile men with low AR levels and in the normal men, mean LH levels were significantly elevated in this group (7.1 vs. 3.6 IU/L), the higher values being a result of increased LH pulse amplitude (mean, 5.6 vs. 2.8 IU/L). The LH-testosterone product (an index of androgen resistance) was also elevated in these men. When infertile men with low AR levels were matched with infertile men with normal receptor levels, the mean LH values were significantly elevated in the former, as was the LH-testosterone product. Testosterone values were similar in the two groups of men. After excluding subjects with chromosomal disorders, there were no significant correlations between AR levels and other indices of androgen action, such as semen volume, seminal fructose, or sex hormone-binding globulin levels. We conclude that AR levels are higher in patients with severe testicular failure associated with X-chromosome disorders. Also, AR defects were found in 19.0% of infertile men with idiopathic oligospermia. Finally, elevation of mean LH levels in men with seminiferous tubule disorders may reflect resistance to androgen action.

Adult↗
PubMed2004

Idiopathic or hypogonadal osteoporosis in men: current and future treatment options.

Osteoporosis is being recognized increasingly in men, and represents a substantial public health problem. As the male population ages and lives longer, the incidence of osteoporotic fractures is expected to increase. The current lifetime risk for a fragility fracture is approximately 27% in men aged 50 years or more, and will increase further over the next 20 years. A major problem with osteoporosis in men is that it continues to be unrecognized, and the majority of men with fragility fractures due to osteoporosis are not being treated. A higher level of awareness is required amongst both general practitioners and the general public that osteoporosis is a treatable condition that can affect men. Secondary causes for osteoporosis are more common in men than in women, and require rigorous exclusion and treatment. Undiagnosed clinical hypogonadism is a common cause of osteoporosis in men, and is readily treatable. The cause of primary osteoporosis in men is unknown, but it results in an osteoblast defect. Genetic factors are likely to be important. In some but not all men, relative estrogen deficiency contributes to rapid rates of age-related bone loss and fractures. An adequate calcium intake, regular weight-bearing exercise, and normal vitamin D status are all very important, particularly with increasing age. The role of testosterone in treating eugonadal men with osteoporosis is currently unclear, and larger prospective studies will be required to carefully evaluate the benefits and risks of therapy. First-line treatment of osteoporosis in hypogonadal or eugonadal men is with bisphosphonates. Alendronate increases bone density and reduces vertebral fractures measured using a semiquantitative method in eugonadal or hypogonadal men with osteoporosis. In the near future, it is likely that subcutaneous human parathyroid hormone (1-34) or teriparatide will also be available as an important new anabolic treatment for men with osteoporosis. Teriparatide treatment also increases bone density in men. Selective estrogen receptor modulating drugs require further evaluation in men, but would appear to theoretically benefit men, especially those with low estradiol levels. In the future, selective androgen receptor modulating drugs may be useful in the prevention and treatment of osteoporosis, and in increasing lean body mass in men, without having adverse effects on prostate and breast tissue.

Endocrinology↗
PubMed2000

Mortality among men using homeless shelters in Toronto, Ontario.

CONTEXT: Homeless persons in US cities have high mortality rates. However, few comparison data exist for death rates among homeless persons in other developed countries. OBJECTIVES: To compare mortality rates among men using homeless shelters and the general population in Toronto, Ontario, and to determine whether mortality rates differ significantly among men using homeless shelters in Canadian and US cities. DESIGN: Cohort study conducted from 1995 through 1997, with a mean follow-up of 2.6 years. PARTICIPANTS: Men aged 18 years or older who used homeless shelters in Toronto in 1995 (n=8933). MAIN OUTCOME MEASURE: Mortality rate ratios comparing age-specific mortality rates among men using homeless shelters in Toronto with those of men in the general population of Toronto and of men using homeless shelters in New York, NY; Boston, Mass; and Philadelphia, Pa. RESULTS: Men using homeless shelters in Toronto were more likely to die than men in the city's general population. Mortality rate ratios were 8.3 (95% confidence interval [CI], 4.4-15.6) for men aged 18 to 24 years, 3.7 (95% CI, 3.0-4.6) for men aged 25 to 44 years, and 2.3 (95% CI, 1.8-3.0) for men aged 45 to 64 years. In most cases, however, the risk of death was significantly lower for men using homeless shelters in Toronto than for those in US cities. For men aged 25 to 44 years using homeless shelters, mortality rate ratios were 0.52 (95% CI, 0.41-0.65) for Toronto compared with Boston and 0.61 (95% CI, 0.44-0.85) for Toronto compared with New York City. For men aged 35 to 54 years using homeless shelters, the mortality rate ratio was 0.42 (95% CI, 0.27-0.66) for Toronto compared with Philadelphia. CONCLUSIONS: Mortality rates among men who use homeless shelters in Toronto, while higher than in the general population of Toronto, are much lower than mortality rates observed among men using homeless shelters in 3 major US cities. Further study is needed to identify the reasons for this disparity.

Adult↗