For and against: The male menopause--does it exist?

Correlation analysis of bone metabolism indices and glycosylated hemoglobin in middle-aged and older adult patients with type 2 diabetes mellitus

This study aimed to evaluate the association between bone metabolism indices and glycated hemoglobin (HbA1c) levels in middle-aged and older adult patients with type 2 diabetes mellitus (T2DM). We retrospectively analyzed 372 T2DM patients aged > 45 years who had attended the Endocrinology Department at our hospital (males, n = 192; postmenopausal females, n = 180). We collected data concerning patient characteristics, HbA1c levels, and bone metabolism indices (25-hydroxyvitamin D [25(OH)D], β-isomerized C-terminal telopeptides, N-terminal osteocalcin [N-MID], procollagen type 1 N-terminal propeptide [P1NP], bone-specific alkaline phosphatase [BAP], calcium [Ca], and phosphorus [P]). Study patients were divided into 3 groups according to their HbA1c levels: Group A, HbA1c < 7.5%; Group B, HbA1c 7.5 to 8.9%; and Group C, HbA1c ≥ 9.0%. Pearson correlation was used to determine the correlation between HbA1c levels and the bone metabolism indices. Multiple linear regression analysis was performed to identify factors influencing HbA1c in T2DM patients. Among the 3 groups, no differences were observed in 25(OH)D, β-CTx, Ca, or P indices among the 3 groups, whereas a statistically significant difference in N-MID was observed. Pearson correlation analysis showed an inverse correlation between HbA1c levels and N-MID and no correlation with other bone metabolism indices. Multiple linear regression analysis showed that N-MID was a factor influencing HbA1c levels after adjusting for age and body mass index (BMI). Serum N-MID levels negatively correlated with HbA1c levels in middle-aged and older adult men with T2DM. Therefore, high serum N-MID levels may contribute to blood glucose control in T2DM patients.

Impact of Andropause on Multiple Sclerosis

Andropause results from the natural decrease in testosterone levels that occurs with age. In contrast to menopause, which is a universal, well-characterized process associated with absolute gonadal failure, andropause ensues after gradual decline of both hypothalamic-pituitary-gonadal axis activity, as well as of testicular function, a process which usually develops over a period of many years. Increasing evidence on greater risk of Multiple sclerosis (MS) associated with lower testosterone levels is being reported. Likewise, epidemiological studies have shown a later age of onset of MS in men, relative to women, which could perhaps respond to the decline in protective testosterone levels. In this review, we will discuss the role of androgens in the development and function of the innate and adaptive immune response, as well as in neuroprotective mechanisms relevant to MS. Testosterone effects observed in different animal models and in epidemiological studies in humans will be discussed, as well as their correlation with physical disability and cognitive function levels. Finally, published and ongoing clinical trials exploring the role of androgens, particularly at key stages of sexual maturation, will be reviewed.

Sex-related differences in bone metabolism in osteoporosis observational study

Although the incidence is lower in men than women, osteoporosis remains a significant health issue in men as it may give rise to severe complications if not managed appropriately. As men and women show different biological and social backgrounds, we retrospectively evaluated the differences in the bone metabolism between men and women using bone biomarkers.Bone mineral density (BMD) was determined in all patients using dual-energy X-ray absorptiometry (DXA) and analyzing various bone biomarkers such as carboxyl-terminal collagen crosslinks (CTX), osteocalcin (OCT), and alkaline phosphatase (ALP). The CTX/OCT ratio was used to estimate the association between bone absorption and formation.OCT, CTX, and ALP levels were elevated in patients with osteoporosis. Women displayed a higher incidence of osteoporosis and greater reduction in BMD than men. The mean OCT level in men was lower than that in women. Moreover, men showed significantly lower OCT levels than women of aged 65 and under 80 years old. Among patients with osteoporosis, men had a higher ratio of bone markers than women.Levels of biomarkers of bone formation and absorption were increased in the osteoporosis group. However, men showed lower increases in bone formation biomarkers than did women, indicating that the rate of bone formation relative to bone absorption did not increase in men compared with that in women. Therefore, we suggest that men and women have different bone metabolism in old age.

A systematic review and meta-analysis of behavioural sex differences in executive control

Literature investigating whether an individuals' sex affects their executive control abilities and performance on cognitive tasks in a normative population has been contradictory and inconclusive. Using meta-analytic procedures (abiding by PRISMA guidelines), this study attempts to identify the magnitude of behavioural sex differences in three prominent executive control domains of cognitive set-shifting, performance monitoring, and response inhibition. PubMed, Web of Science, and Scopus were systematically searched. Across 46 included studies, a total of 1988 females and 1884 males were included in the analysis. Overall, males and females did not differ on performance in any of the three domains of performance monitoring, response inhibition, or cognitive set-shifting. Task-specific sex differences were observed in the domains of performance monitoring, in the CANTAB Spatial Working Memory task-males scored statistically higher than females (Hedges' g = -0.60), and response inhibition, in the Delay Discounting task-females scored statistically higher than males (Hedges' g = 0.64). While the meta-analysis did not detect overall behavioural sex differences in executive control, significant heterogeneity and task-specific sex differences were found. To further understand sex differences within these specific tasks and domains, future research must better control for age and sex hormone levels.

Caring for parents: an evolutionary rationale

BACKGROUND

The evolutionary roots of human moral behavior are a key precondition to understanding human nature. Investigations usually start with a social dilemma and end up with a norm that can provide some insight into the origin of morality. We take the opposite direction by investigating whether the cultural norm that promotes helping parents and which is respected in different variants across cultures and is codified in several religions can spread through Darwinian competition.

RESULTS

We show with a novel demographic model that the biological rule "During your reproductive period, give some of your resources to your post-fertile parents" will spread even if the cost of support given to post-fertile grandmothers considerably decreases the demographic parameters of fertile parents but radically increases the survival rate of grandchildren. The teaching of vital cultural content is likely to have been critical in making grandparental service valuable. We name this the Fifth Rule, after the Fifth Commandment that codifies such behaviors in Christianity.

CONCLUSIONS

Selection for such behavior may have produced an innate moral tendency to honor parents even in situations, such as those experienced today, when the quantitative conditions would not necessarily favor the maintenance of this trait.

Sex-Based Differences in the Determinants of Old Age Life Expectancy: The Influence of Perimenopause

Studies using the sensitive periods framework typically examine the effects of early life exposures on later life health, due to the significant growth and development occurring during the first few years of life. The menopausal transition (i.e., perimenopause) is similarly characterized by rapid physiological change, yet rarely has been tested as a sensitive window in adulthood. Cohort mortality data drawn from three historic populations, Sweden (1751-1919), France (1816-1919), and England and Wales (1841-1919), were analyzed using time series methods to assess whether conditions at midlife significantly influenced or "programmed" later life longevity. Results indicated a significant inverse association between mortality at ages 45-49, the average age range in which perimenopause occurred, and life expectancy at age 60 among females in all three countries. Study findings suggest a degree of plasticity associated with women's aging and, in particular, the age group correlated with perimenopause.

Autoimmune diseases and reproductive aging

As the population ages, more individuals with autoimmune diseases are experiencing reproductive senescence. Understanding the impact of menopause and age-related androgen decline on disease onset and course, as well as the potential for hormonal interventions, is critically important. In men, lupus erythematosis (SLE), rheumatoid arthritis (RA), and multiple sclerosis (MS) are associated with lower androgen levels. However, the impact of age-related declines in testosterone, as well as of testosterone replacement, on disease course remains underexplored. In women, the course of all three diseases with onset after the age of menopause differs from that with onset before menopause. Early age at menopause is associated with increased disease risk, and after menopause, disease course changes in SLE and RA. Less is known about MS. This article summarizes what is known about the relationship between reproductive aging and autoimmune diseases in men and women, and highlights areas for further investigation.

Perspectives for metabolomics in testosterone replacement therapy

Testosterone is the major circulating androgen in men but exhibits an age-related decline in the ageing male. Late-onset hypogonadism or androgen deficiency syndrome (ADS) is a 'syndromic' disorder including both a persistent low testosterone serum concentration and major clinical symptoms, including erectile dysfunction, low libido, decreased muscle mass and strength, increased body fat, decreased vitality or depressed mood. Given its unspecific symptoms, treatment goals and monitoring parameters, this review will outline the various uncertainties concerning the diagnosis, therapy and monitoring of ADS to date. Literature was identified primarily through searches for specific investigators in the PubMed database. No date or language limits were applied in the literature search for the present review. The current state of research, showing that metabolomics is starting to have an impact not only on disease diagnosis and prognosis but also on drug treatment efficacy and safety monitoring, will be presented, and the application of metabolomics to improve the clinical management of ADS will be discussed. Finally, the scientific opportunities presented by metabolomics and other -omics as novel and promising tools for biomarker discovery and individualised testosterone replacement therapy in men will be explored.

Change in testosterone concentrations over time is a better predictor than the actual concentrations for symptoms of late onset hypogonadism

BACKGROUND

Symptoms of late-onset hypogonadism (LOH) and concentrations of testosterone (T) and bioavailable testosterone (BT) were studied in relation to the data from the same men 5 years earlier.

METHODS

In 2008, 282 men, aged 60-82 years, answered a questionnaire regarding demographic data, medical history, different symptoms of LOH and the 10 questions from the 'Androgen Decline in Aging Males (ADAM)-questionnaire'. Blood samples were analysed for concentrations of T and calculations were made for BT.

RESULTS

A total of 87.2% of the questionnaires were returned and analysed, and 75.2% of the responders gave blood samples. The oldest third of the men were most affected by LOH symptoms (p < 0.05). Both T and BT concentrations decreased during the 5 years (p < 0.05) but only the symptom 'less strong erections' changed significantly (p < 0.05). Men reporting one of the four specific symptoms from the 'ADAM-questionnaire' for the first time in 2008 had a higher loss of T and BT than men who had unchanged or fewer symptoms than that reported in 2003.

CONCLUSIONS

The magnitude of the decrease in concentrations is a better predictor of LOH than are the actual concentrations of T and BT. A combination of symptoms predicts LOH better than any single symptom.

More than half of the men in a Swedish population of men aged 55, 65 and 75 believe in 'a male climacteric'

AIM

Symptoms of late-onset hypogonadism (LOH) are often unspecific, and the existence of a male climacteric has been much debated. In this study, we investigate aging men's thoughts about, and beliefs, in a 'male climacteric'.

METHODS

A questionnaire was developed including background demographic data, symptoms possibly related to LOH and questions about men's thoughts and beliefs in a 'male climacteric'. All men, 55-, 65- and 75-years old, living in Linkoping, Sweden (n=1885) received the questionnaire.

RESULTS

One thousand three hundred fifty-six (72%) questionnaires were eligible for evaluation, 65.4% of the responders had heard of a 'male climacteric', and 42.2% believed it existed but only 3% had sought medical advice for these symptoms. More than half believed that a 'male climacteric' was related to decreased libido and less strong erections. Almost half of the men thought that decreased memory and/or dystymia and anxiousness were related to a male climacteric.

CONCLUSIONS

The majority of men have heard of a male climacteric, but only a minority had consulted a practitioner about their symptoms. More information and knowledge are needed, for the general population to better motivate men to seek medical advice and also for the health care professionals to better deal with the symptoms of LOH.

Awareness and knowledge of andropause among Chinese males in Hong Kong

This is a pilot study that explored the awareness and knowledge of andropause among Chinese males in Hong Kong. The study employed a structured questionnaire and a convenience sample of 500 individuals at the age > or =40 years participated in the survey. A total of 397 (79.4%) of the respondents were identified as andropause-enlightened, 88.2% of whom believed that andropause was a natural aging process. Mass media was the main source of andropausal information. The andropause-enlightened respondents had poor knowledge with the mean knowledge score of 5.94. The majority identified irritability (72.5%), loss of energy (66.5%), and loss of libido (60.7%) as symptoms. Less than half of the andropause-enlightened respondents expressed that andropause could be treated and only 34 knew testosterone replacement therapy as a treatment. The present findings underscore the need for provision of health education to increase the knowledge of andropause among adult males.

Testosterone correlated to symptoms of partial androgen deficiency in aging men (PADAM) in an elderly Swedish population

OBJECTIVE

To investigate the prevalence of different symptoms of partial androgen deficiency in aging men (PADAM) and to correlate them with blood concentrations of testosterone and bioavailable testosterone.

DESIGN

A total of 370 men, aged 55 to 75 years, were invited to one of three primary healthcare centers in Sweden. They were asked to complete a questionnaire regarding demographic data, medical history, mood status, medication, castration therapy and smoking, exercise and alcohol habits, as well as different symptoms of PADAM. The 10 questions from a previously used questionnaire (the ADAM questionnaire) were included. The men were offered blood tests for analyses of testosterone, follicle stimulating hormone, luteinizing hormone, steroid hormone-binding globulin, and albumin. From these test results, we calculated the bioavailable testosterone.

RESULTS

Of the questionnaires sent out, 81.6% were returned and eligible for evaluation. Blood samples were obtained from 85.8% of men answering the questionnaire. Many of the symptoms, including five from the ADAM questionnaire, were more common in older age groups (P < 0.05). Three symptoms, deterioration in work performance, decreased strength and/or endurance, and bothersome hot flushes, were associated with low bioavailable testosterone and/or testosterone (P < 0.05). Testosterone and bioavailable testosterone did not differ between age groups, but bioavailable testosterone was higher in men with three or fewer symptoms on the ADAM questionnaire.

CONCLUSIONS

Symptoms associated with PADAM often occur in an elderly population, but we could only find an association between three symptoms and blood testosterone concentrations, one being bothersome hot flushes. It is likely that these symptoms have a more complex background than only PADAM.

The medicalisation of male menopause in America

The topic of male menopause occupied space on the medical radar screen from the late 1930s through the mid-1950s, then virtually disappeared for the next four decades, until the late 1990s. By contrast, articles on this subject appeared in American popular magazines and newspapers at a consistent, if low-level, rate throughout the same period. This essay describes how the male menopause became medicalised, not by the driving forces of academic researchers and influential clinicians, but instead by a model perpetuated by lay people and medical popularisers. A medicalised conceptualisation of the body and the life-cycle had become widespread by the second half of the twentieth century, as Americans grew accustomed to regarding their lives through the lens of medicine. People came to expect medicine to provide a cure for any ailment; in the wake of the development of the so-called wonder drugs, no affliction seemed beyond medical and pharmaceutical intervention. A medicalised model had also been effectively produced for understanding and treating the menopause in women; a parallel, if not identical, stage in the life-course of men seemed reasonable. This framework, rather than persuasive evidence from the research laboratory or clinic, helped to medicalise male menopause and provided the basis for its eventual pharmaceuticalisation at the end of the twentieth century.

Does the Aging Males’ Symptoms scale assess major depressive disorder?: A pilot study

OBJECTIVES

The objectives of the study were to find the prevalence of major depressive disorder (MDD) in male climacteric outpatients in Japan, and to determine whether symptoms on the Aging Males' Symptoms (AMS) scale scores differed between patients with and without MDD, with the aim of increasing the specificity of future symptoms scales for partial androgen deficiency of the aging male (PADAM).

METHODS

Eighty-three patients aged 40-70 who visited the male-climacteric services as outpatients were assessed using three items: a self-administered questionnaire corresponding to diagnosis for MDD, the Beck Depression Inventory, and the AMS scale.

RESULTS

Almost half the patients had MDD. The total AMS score, the scores on the AMS psychological, somatic and sexual subscales, and the scores for all except three questionnaire symptoms were higher in patients with MDD. There were strong correlations between the AMS scale and the Beck Depression Inventory.

CONCLUSIONS

There is a higher prevalence of MDD in male-climacteric outpatients and scores on most items of the AMS scale were higher for patients with MDD. We suggest that only those symptoms whose scores did not differ between patients with and without MDD are used to assess symptoms of PADAM in the presence of MDD, or that the current AMS is used only after diagnosis of MDD and elimination of these patients. Then the relevance of each item of the AMS to testosterone levels should be simultaneously examined in the future study, which will determine the items highly specific to PADAM symptoms.

Prevalence of symptoms possibly related to PADAM, in a Swedish population aged 55, 65 and 75 years

OBJECTIVES

With age there is an average decline in the concentration of biologically active testosterone. It is still controversial if this leads to a clinically relevant deficit, "partial androgen deficiency of the ageing man" (PADAM). Our objective was to investigate the prevalence of a series of symptoms possibly associated with PADAM in an assumed normal-population of older men.

METHODS

We developed a questionnaire including items about symptoms possibly associated with PADAM as well as background data covering demography, medical history, mood status, medication, castration therapy, as well as smoking, exercise and alcohol habits. The 10 items of the ADAM-questionnaire, designed to predict low bio-available T, were also included. The questionnaire was sent to all 1885 men 55, 65 or 75-years-old, living in Linköping, Sweden.

RESULTS

We identified a number of symptoms that differed significantly (P < 0.01) between age groups, e.g., "increased abdominal circumference", "decrease in muscle strength and/or endurance", "decreased libido", "less strong erection" and "lack of energy". From factorial analysis we found that the symptoms co-varied in four different groups.

CONCLUSION

The prevalence of a number of symptoms differed significantly between age groups, but we cannot infer that there is a causal connection between an average age-dependent decline in testosterone function and these symptoms. There are several other ways to interpret these results like the existence of concurrent somatic and/or mood disorders or ageing as such. For this purpose further studies including measurements of testosterone concentrations relating to the findings of this study have to be performed.

Age-related changes in hemispheric asymmetry depend on sex

A total of 92 participants, 50 younger (mean age 26.3 years) and 42 older (mean age 63.8 years), were tested for visual-field asymmetries. On a word-matching task, a right-visual-field (RVF) advantage increased with age, consistent with the theory that right-hemispheric function shows relatively greater decline with age than left-hemispheric function. On a figural-comparison task, a left-visual-field (LVF) advantage was marginally decreased with age in the men, but significantly increased in the women, probably because age-related changes in hormonal levels are more pronounced in women. This increase in LVF advantage is contrary to both the HAROLD theory that hemispheric asymmetry declines with age, and the theory of relative right-hemispheric decline.

The reliability of clinical and biochemical assessment in symptomatic late-onset hypogonadism: can a case be made for a 3-month therapeutic trial?

OBJECTIVE

To assess whether testosterone (T) supplementation in men considered to have symptomatic late-onset hypogonadism (SLOH) can be evaluated clinically and biochemically.

PATIENTS AND METHODS

To assess the relevance of the clinical and biochemical diagnosis of hypogonadism we investigated patients referred for the diagnosis and treatment of SLOH. Patients were assessed clinically and completed a screening questionnaire. The pituitary-adrenal-gonadal axis was comprehensively assessed biochemically. Those with a clinical diagnosis of hypogonadism and serum levels of T supporting such a diagnosis received exogenous T for >/= 3 months and were assessed for any clinical and biochemical response. Of an initial group of 45 men (mean age 59.2 years) 38 completed the study.

RESULTS

Most men presented with symptoms of sexual dysfunction, lack of energy and/or depression. There were differences before and after treatment only in bioavailable T (BT), with none in the levels of total T (TT). There was a strong correlation before and after treatment in the levels of luteinizing hormone and follicle-stimulating hormone, and a weak negative correlation between gonadotrophins and BT. Neither TT nor BT had predictive value for the treatment response. There was a trend to a correlation between BT levels and treatment success. Changes in serum prostate specific antigen were insignificant during the limited period.

CONCLUSION

The lack of accurate methods for diagnosing SLOH suggests that a therapeutic trial of T supplementation is warranted in men in whom there are no contraindications. The 3-month period largely circumvents the placebo effect and has minimal risks for serious adverse effects (mostly in relation to prostate safety). This controversial position needs further evaluation with a larger cohort and other biochemical measurements.

The male menopause: possible causes, symptoms and treatment

This article discusses the controversial concept of the male menopause, by explaining what the literature reveals about this condition. It does not wish to put forward a case for treating men with the male menopause with hormone replacement therapy, merely to provide information to nurses who may nurse men with the symptoms associated with the disorder. Definitions of key terms, i.e. male menopause, are considered and the endocrinological changes that occur with ageing are outlined. Assessment of the extent of the problem is confounded by the concept of definition. Some middle-aged men often describe similar symptoms that women describe associated with the menopause; therefore it may be reasonable to suggest that an andropause with an endocrine basis does exist. The investigations undertaken to make a diagnosis are described and treatments available are discussed. A shared approach to the care for men with menopausal symptoms is advocated. The role the nurse plays is described and recommendations for practice suggested. Finally, a conclusion is offered and a call is made for further empirical investigations to be made available, to ensure that men are provided with safe effective care based on the best available evidence.

Hot flushes in a male population aged 55, 65, and 75 years, living in the community of Linköping, Sweden

OBJECTIVE

Hot flushes are as common in castrated men as in menopausal women. We investigated whether hot flushes exist in a normal aging male population and to what extent.

DESIGN

A questionnaire was sent to all men living in Linköping, Sweden, who were 55, 65, and 75 years old ( = 1,885). The questionnaire asked for demographic data, medical history, mood status, medication, castrational therapy, and smoking, exercise, and alcohol habits, among other items. We asked specifically for current hot flushes unrelated to exercise or a warm environment.

RESULTS

Of the questionnaires received, 1,381 were eligible for evaluation; 33 were analyzed separately because these men had been castrated. Hot flushes of any frequency were reported by 33.1% of noncastrated men, 4.3% reported flushes at least a few times per week, and 1.3% reported daily flushes. Half of the men reporting flushes were also bothered by them, ie, almost every sixth man in total. We found a relation between occurrence of hot flushes and other symptoms thought to be related to low testosterone concentration, such as decreased muscle strength or endurance, decreased enjoyment of life, sadness or grumpiness, and lack of energy ( < 0.05).

CONCLUSIONS

Hot flushes occur in one third of a population of noncastrated older men, approximately half of whom consider flushes as bothersome. Neither the mechanisms nor whether the symptoms would respond to testosterone supplementation is known. Androgen substitution to treat symptoms possibly related to a male climacteric is still controversial. Studies are needed to evaluate the needs for and the effects of androgen treatment on vasomotor symptoms.

Andropause: knowledge and perceptions among the general public and health care professionals

BACKGROUND

Andropause, the natural age-related decline in testosterone in men, has been debated in the literature. The nonsexual benefits of testosterone replacement therapy (TRT) in male hypogonadism are well documented, but whether health care professionals (HCPs) and members of the general public are aware of these benefits is not known. This study assesses the knowledge and perceptions of andropause and TRT among HCPs and members of the general public.

METHODS

Brief surveys were administered to HCPs and members of the general public who called a medical information telephone line. Trained clinical interviewers surveyed participants for experiences with andropause and TRT and knowledge about nonsexual effects of low testosterone in men.

RESULTS

Of 443 general public callers, 377 (85%) agreed to participate in the survey. Of these participants, 77% had heard of andropause or male menopause, and 63% had taken TRT. Of 88 HCP callers, 57 (65%) participated. Of these participants, 65% were pharmacists, 80% had encountered patients with symptoms of low testosterone, and 50% reported that patients rarely or never initiated conversations about low testosterone. Among HCPs and the general public, respectively, 98% and 91% knew that low testosterone is treatable with medication, and 60% and 57% knew that it results in osteoporosis. Only 25% of HCPs and 14% of the general public knew that low testosterone does not cause loss of urinary control.

CONCLUSIONS

HCPs and members of the general public are knowledgeable about some aspects of low testosterone and have misconceptions about others. Educational initiatives are needed.