Metabolic syndrome and the older male population

Testosterone and aging male, a perspective from a developing country

PURPOSE

Hypogonadism is associated with a wide range of physical and psychological symptoms that can affect the overall health of men. However, in a developing country, there are several imposing challenges in the diagnosis and treatment of hypogonadism, including a lack of awareness and understanding of the condition among healthcare providers and patients, limited resources and the high cost of treatment. This review aimed to examine the potential benefits and risks of testosterone replacement therapy (TRT) and provides a perspective of a developing country on the topic.

MATERIALS AND METHODS

A comprehensive literature review was conducted to gather relevant information on the impact of testosterone deficiency on ageing males and the effectiveness of TRT for treating hypogonadism. Published peer-reviewed articles were analyzed to evaluate the benefits and risks of TRT. Additionally, the unique challenges faced in the diagnosis and treatment of hypogonadism in a developing country were considered.

RESULTS

Testosterone replacement therapy has been shown to be an effective treatment for hypogonadism, particularly in symptomatic men with low testosterone levels. It offers potential benefits such as improvements in symptoms and overall quality of life. However, there are associated risks and side effects that need to be considered. In a developing country, challenges such as limited awareness and understanding of hypogonadism, resource constraints, and high treatment costs pose additional barriers to accessing TRT and comprehensive care.

CONCLUSION

In conclusion, TRT holds promise as a treatment for hypogonadism, but its implementation and accessibility face significant challenges in a developing country. Addressing these challenges, including raising awareness, allocating resources, and finding cost-effective solutions, is crucial for ensuring that men with hypogonadism in such settings receive appropriate diagnosis and treatment. Further research and efforts are needed to improve the management of hypogonadism in developing countries and optimize the potential benefits of TRT for affected individuals.

"Aging males" symptoms and general health of adult males: a cross-sectional study

A cross-sectional study was conducted to explore the prevalence and severity of health-related complaints perceived by adult males of Hong Kong by using the Hong Kong Traditional Chinese versions of the Aging males' symptoms (AMS) scale and the 5-dimensional and 3-level European Quality of life (EQ-5D-3L) questionnaire. A total of 825 adult males aged 40 years or above were surveyed, and observed that 80% of the population was living with little-to-mild levels of aging symptoms with mean total scores ranged between 26.02 ± 7.91 and 32.99 ± 7.91 in different age groups. Such symptoms were correlated with age, especially for the somato-vegetative and sexual symptoms. The most severe AMS symptoms were observed in the oldest age group at 70 years or above, with 76%, 34% and 70% living with moderate-to-severe levels of somato-vegetative, psychological and sexual symptoms, respectively. The result was highly correlated with the EQ-5D-3L questionnaire. Secondly, the Hong Kong Aging males' symptoms (AMS) scale was shown to have good reliability with test-retest coefficient at 0.79 (ranged 0.66-0.87) and Cronbach's alpha coefficient at 0.88 (ranged 0.70-0.84). In summary, the population of Hong Kong male adults was commonly living with little-to-mild levels of aging symptoms, whereas their severity was correlated with age.

Aging, components of metabolic syndrome and serum C-reactive protein showed significant relationship with carotid atherosclerosis

OBJECTIVE

metabolic syndrome (MetS) is known to be associated with an increased risk for cerebro- as well as cardio-vascular disease. Prediction of carotid atherosclerosis by components of MetS, serum C-reactive protein, aging and related factors was conducted for Japanese inhabitants.

METHODS

A total of 887 subjects (761 males, 126 females) were included in the present study. Early atherosclerosis was assessed by measurement of the intima-media thickness of the common carotid arteries.

RESULTS

The carotid arterial intima-media thickness on both the right and left sides significantly increased as the number of components of MetS increased. The maximum intima-media thickness values in the right (left) carotid arteries in the male and female subjects who fulfilled the criteria for MetS were 0.65 ± 0.18 (0.66 ± 0.17) mm and 0.58 ± 0.12 (0.59 ± 0.11) mm, respectively. After adjustment for several factors, the intima-media thickness related significantly with aging, some components of MetS and serum C-reactive protein by multiple regression analysis. β-coefficient of age was largest, presenting 0.457 in right side and 0.479 in left side.

CONCLUSIONS

Aging, metabolic components and serum C-reactive protein are independent predictors of intima-media thickness in subjects.

The metabolic syndrome in older persons

The metabolic syndrome is one of several patterns of risk for atherosclerotic cardiovascular disease. Although the concept of the metabolic syndrome has been known for 2 centuries or more, it is only recently that its individual components have been proposed. Visceral obesity is a central component but other major facets such as hypertension, dyslipidemia, or dysglycemia are often present. These components are well-established cardiovascular risk factors and therefore grouping them under a single entity, namely the metabolic syndrome, has questioned its clinical usefulness and its ability to predict cardiovascular disease. Depending on what criteria are used, the prevalence of this syndrome may be as much as 40% in those aged 60 years and older. Heredity, environmental factors, personal lifestyle habits and behavior, and clinical comorbidities all seem to be associated with the metabolic syndrome. In addition, hypogonadism in men and hypovitaminosis D are age-related issues associated with the metabolic syndrome. In ageing individuals the existence of the metabolic syndrome as a distinct entity is questioned although some studies report an association with diabetes mellitus, physical impairments, and cognitive dysfunction. Further studies that explore these factors over time are needed but for now, treatment remains focused on individual components and not on the syndrome as a whole.

Nutrition and the aging male

Numerous studies have now found that good nutrition coupled with exercise are key factors to aging successfully. In addition, it is now clear that men who drink 2 shots of alcohol (red wine or other) do better. Women are limited to only 1 drink a day. This article examines some key nutritional factors involved in successful aging and highlights different needs between men and women.

Diabetes and aging: epidemiologic overview

Diabetes mellitus has long been recognized as a cause of accelerated aging. As the understanding of the metabolic syndrome has evolved, it has been recognized that the interaction of a panoply of factors in the presence of insulin resistance results in accelerated aging. This article explores the increasing prevalence of diabetes mellitus with aging and how insulin resistance leads to accelerated frailty, disability, hospitalization, institutionalization, and death.

Insulin resistance syndrome and glucose dysregulation in the elderly

The incidence of insulin resistance in the geriatric population is growing as this population grows. The management of hyperglycemia and its associated risk factors depends on an expanding understanding of the underlying pathophysiology and progression of disease and of the currently available and future therapeutics, which are continually evolving. There is a major need for studies in the long-term care setting to determine the appropriate standard of care in prevention and treatment of metabolic dysregulation.

Evidence rocks in long-term care, but does it roll?

This article reviews the problems with the implementation of evidence-based care in long-term care. It highlights the fact that many common practices are incompatible with evidence and that available evidence, including evidence about inadvisable and ineffective treatments, is often not followed. Often, there is a tendency to follow recommendations for younger persons (for example, the management of hypertension and elevated cholesterol), or to use questionable interventions (for example, choices for treating constipation). In many cases, the treatments used have only marginal efficacy and increased potential for side effects. This article makes recommendations for improving the approach to evidence-based care in long-term care and strongly urges the FDA to require drug studies in nursing homes.

Intensive Session: New Approaches to Medical Issues in Long-Term Care

This article, based on a series of presentations at the American Medical Directors Association, briefly highlights new advances in medical areas of interest to long-term care physicians. The areas discussed are heart failure, vitamin D, falls, new treatments for diabetes mellitus, blood pressure measurement, anemia, clinical nutrition, pressure ulcers, Clostridium difficile, insomnia, and antipsychotic therapy.