Medical management of erectile dysfunction in aging males： is it too late to treat？

Erectile dysfunction （ED） is a common disorder among aging males. However, most aging males refuse to seek medical help and believe that ED is an irreversible event in the aging process. The purpose of this study was to describe the current medical management of ED in aging males and to examine whether it is too late to treat this disorder in these elderly men. From 2007 to 2008, 4507 patients diagnosed with ED were gathered from 46 centers in China; 4241 completed the study, 3837 of whom were treated with sildenafil. The 3837 patients were divided into five groups based on age （group A： 20-30 years; group B： 31-40 years; group C： 41-50 years; group D： 51-60 years; and group E： 〉60 years）. After comparing pre- and posttreatment International Index of Erectile Function-Erectile Function domain （IIEF-EF） questionnaires, Erection Hardness Scale （EHS）, and IIEF Q13 （＂How satisfied have you been with your overall sex life？＂）, we discovered that the aging males had worse erectile function, erection hardness, and sexual satisfaction than the younger males （P〈 0.001）. After treatment, the improvement rates in the IIEF-EF, EHS, and IIEF Q13 scores were 107.0%, 83.1%, and 116.5%, respectively. The magnitude of these changes demonstrated significant differences among groups （P 〈 0.001）. Accordingly, aging males are likely to benefit more from medical treatment. We propose that aging males should be informed that age is not a limiting factor for medical ED management, and it is never too late to treat.

Preli minary Study on Treat ment of Partial Androgen Deficiencyin Aging Males with Jingui Shenqi Pill (金匮肾气丸)

Objective： To observe the efficacy and safety of Jingui Shengqi Pill （金匮肾气丸, JSP） in treating partial androgen deficiency in aging males （PADAM）, and to explore the new approach in improving the quality of life in PADAM patients. Methods： Forty patients with PADAM were treated with JSP, the efficacy was evaluated with international index of erectile function （IIEF） scoring, PADAM questionnaire scoring, hormone, prostatic specific antigen （PSA）, etc., and the data before treatment were compared with those after treatment in the same group. Results： After 3 months of treatment, PADAM scoring and IIEF scoring were all significantly improved. Symptoms regarding physical ability, vasomotion, and psychical and mental condition all got improved more markedly than symptoms regarding sexual hypofunction. The serum level of testosterone was 3.85±0.36 before treatment and 5.02±0.83 after treatmnet （P〈0.05）; luteinizing hormone of 7.33±2.14 and 4.84±1.43 （P〈0.01）, follicule-stimulating hormone of 10.22±4.48 and 6.47±3.28 （P〈0.01）, respectively. The level of PSA failed to change significantly （1.94±0.55 and 2.06±0.47, P〉0.05）. Conclusion： JSP is effective and safe in treating PADAM, the mechanism of it is different from supplementing extrinsic androgen. It may have produced the effect by means of favorably regulating the condition of sex hormone to improve the balance of pituitary-sex gland axis, so it has more extensive clinical application.

Survey for late-onset hypogonadism among old anti middle-aged males in Shanghai communities

This study sought to investigate late-onset hypogonadism （LOH） in old and middle-aged males in Shanghai communities, using symptom score evaluation systems and measurements of sex hormone levels. One thousand cases of males aged 40-70 years were investigated. The aging male symptoms （AMS） scale and androgen deficiency in aging males （ADAM） questionnaire were used at the beginning of the investigation, followed by measurement of the sex hormone-related factors （total testosterone （TT）, free testosterone （fT）, sex hormone-binding globulin （SHBG） and bioavailability of testosterone （Bio-T））. There were 977 valid questionnaires. The LOH-positive rates shown by AMS and ADAM were 59.88% and 84.65%, respectively; values increased with the age of the patients. There were 946 results related to sex hormone measurements, which showed the following results： TT was not related to aging （P〉O.05）; levels of SHBG increased with age; and fT and Bio-T decreased with age. There was a significant difference in fT between LOH-positive and LOH-negative patients, as shown by the ADAM. In summary, TT levels were not related to aging, even though SHBG did increase while fT and Bio-T decreased with aging. Clinically, the diagnosis of LOH cannot be based on serum TT level.

Hormonal replacement therapy and aging: Asian practical recommendations on testosterone supplementation

<abstract>Profound and diffuse alterations in the production of gonadal and adrenal androgens as well as growth hormone are associated with aging. To convey this concept more appropriately, partial endocrine deficiency in the aging male (PEDAM) was introduced as a term for the phenomenon of hormonal alterations in the aging male. Hormones responsible for some of the manifestations associated with male aging are testosterone, growth hormone, dehydroepiansdrosterone (DHEA), melatonin, thyroid hormones and leptin. Of these, testosterone has been widely investigated and its beneficial and adverse effects on male bodily systems are relatively well established. However, a serious body of confusion and misunderstandings surrounding the diagnosis, treatment and monitoring of men suspected of having androgen deficiency has been raised. Therefore, it is timely to provide practical criteria for diagnosis and treatment to avoid misconception about the use of testosterone in the aging male. To provide an understanding and information of the issues, the following headings are summarized: (1) Important clinical consideration on testosterone supplementation in the aging male; (2) Asian practical recommendations on testosterone supplementation in the aging male.

First Asian ISSAM Meeting on the Aging Male, Kuala Lumpur,Malaysia, 1-3 March 2001-an overview

1 Aging in Asia-an avalanche starts to form With decreasing fertilityrate and increasing life expectan-cy, the world is aging- withhighest rates in Asia. The socio-economic, financial and medicalconsequences of the aging popu-

The Asia Pacific Council For Study of The Aging Male (ACSAM)

The Asia Pacific Council for Study of the AgingMale was established on 1 March 2001. In the FoundingMeeting, the Council Functionaries, Mission and Objec-tives were fully discussed and passed.ChairmanTan Hui Meng (Malaysia)

Bazi Bushen alleviates reproductive aging in aged male mice

Bazi Bushen(BZBS),a traditional Chinese medicine(TCM),has demonstrated therapeutic efficacy in testicular dysfunction within D-galactose and NaNO_(2)mouse models.This study aimed to ascertain if BZBS could also mitigate the decline in testicular function associated with natural aging.Therefore,male aged mice were employed to evaluate the preventive effects of BZBS on male reproductive aging.This was achieved by assessing sex hormone production,testicular histomorphology,and spermatogenesis.Relative to the untreated aged control group,BZBS administration elevated the levels of sex hormones and spermatocyte populations and preserved normal testicular structure in aged mice.Notably,spermatogenesis was maintained.Further analyses,including malondialdehyde(MDA)assays and real-time PCR,indicated that BZBS diminished testicular oxidative stress and the inflammatory burden.Corroborating these findings,mice treated with BZBS exhibited reductions in the populations of senescent and apoptotic cells within the seminiferous tubules,suggesting alleviated cellular damage.In contrast,we observed that rapamycin,a drug known for its longevity benefits,induced excessive testicular apoptosis and did not decrease lipid peroxidation.Collectively,our results highlight BZBS’s promising clinical potential in counteracting male reproductive aging,underlining its mechanisms of action.

The testosterone mimetic properties of icariin

Aim： To evaluate the testosterone mimetic properties of icariin. Methods： Forty-eight healthy male Sprague-Dawley rats at the age of 15 months were randomly divided into four groups with 12 rats each： the control group （C）, the model group （M）, the icariin group （ICA） and the testosterone group （T）. The reproductive system was damaged by cyclophosphamide （intraperitoneal injection, 20 mg/kg·day） for 5 consecutive days for groups M, ICA and T, at the sixth day, ICA （gastric gavage, 200 mg/kg·day） for the ICA group and sterandryl （subcutaneous injection, 5 rag/rat.day） for the T group for 7 consecutive days, respectively. The levels of serum testosterone, luteinizing hormone （LH）, follicle stimulating hormone （FSH）, serum bone Gla-protein （BGP） and tartrate-resistant acid phosphatase activity in serum （StrACP） were determined. The histological changes of the testis and the penis were observed by microscope with hematoxylin-eosin （HE） staining and terminal deoxynucleotidyl transferase biotin-dUTP-X nick end labeling （TUNEL）, respectively. Results： （1） Icariin improved the condition of reproductive organs and increased the circulating levels of testosterone. （2） Icariin treatment also improved the steady-state serum BGP and might have promoted bone formation. At the same time, it decreased the serum levels of StrACP and might have reduced the bone resorption. （3） Icarrin suppressed the extent of apoptosis of penile cavernosal smooth muscle cells. Conclusion： Icariin has testosterone mimetic properties and has therapeutic potential in the management of hypoandrogenism.

Late-onset hypogonadism： current concepts and controversies of pathogenesis, diagnosis and treatment

Although suppressed serum testosterone （T） is common in ageing men, only a small proportion of them develop the genuine syndrome of low T associated with diffuse sexual （e.g., erectile dysfunction）, physical （e.g. loss of vigor and frailty） and psychological （e.g., depression） symptoms. This syndrome carries many names, including male menopause or climacterium, andropause and partial androgen deficiency of the ageing male （PADAM）. Late-onset hypogonadism （LOH） describes it best and is therefore generally preferred. The decrease of T in LOH is often marginal, and hypogonadism can be either due to primary testicular failure （low T, high luteinizing hormone （LH）） or secondary to a hypothalamic-pituitary failure （low T, low or inappropriately normal LH）. The latter form is more common and it is usually associated with overweight/obesity or chronic diseases （e.g., type 2 diabetes mellitus, the metabolic syndrome, cardiovascular and chronic obstructive pulmonary disease, and frailty）. A problem with the diagnosis of LOH is that often the symptoms （in 20%-40% of unselected men） and low circulating T （in 20% of men 〉70 years of age） do not coincide in the same individual. The European Male Ageing Study （EMAS） has recently defined the strict diagnostic criteria for LOH to include the simultaneous presence of reproducibly low serum T （total T 〈11 nmol 1-1 and free T 〈220 pmol 1-1） and three sexual symptoms （erectile dysfunction, and reduced frequency of sexual thoughts and morning erections）. By these criteria, only 2% of 40- to 80-year-old men have LOH. In particular obesity, but also impaired general health, are more common causes of low T than chronological age per se. Evidence-based information whether, and how, LOH should be treated is sparse. The most logical approach is lifestyle modification, weight reduction and good treatment of comorbid diseases. T replacement is widely used for the treatment, but evidence-based information about its real benefits and short- and long-term risks, is not yet available. In this review, we will summarize the current conceets and controversies in the Dathogenesis, diagnosis and treatment of LOH.

The effects of advanced paternal age on fertility

Modern societal pressures and expectations over the past several decades have resulted in the tendency for couples to delay conception. While women experience a notable decrease in oocyte production in their late thirties, the effect of age on spermatogenesis is less well described. While there are no known limits to the age at which men can father children, the effects of advanced paternal age are incompletely understood. This review summarizes the current state of knowledge regarding advanced paternal age and its implications on semen quality, reproductive success and offspring health. This review will serve as a guide to physicians in counseling men about the decision to delay paternity and the risks involved with conception later in life.

Advanced paternal age and reproductive outcome

Women have been increasingly delaying the start of motherhood in recent decades. The same trend is seen also for men. The influence of maternal age on fertility, chromosomal anomalies, pregnancy complications, and impaired perinatal and post-natal outcome of offspring, has been thoroughly investigated, and these aspectsare clinically applied during fertility and pregestational counseling. Male aging and reproductive outcome has gained relatively less attention. The purpose of this review is to evaluate updated and relevant literature on the effect of paternal age on reproductive outcome.

Erectile function and late-onset hypogonadism symptoms related to lower urinary tract symptom severity in elderly men

The aim of this study was to evaluate the relationship between lower urinary tract symptoms （LUTSs）, erectile dysfunction （ED） and symptomatic late-onset hypogonadism （SLOH） in ageing men in the Aegean region of Turkey. Five hundred consecutive patients 〉40 years old who had been in a steady sexual relationship for the past 6 months and were admitted to one of six urology clinics were included in the study. Serum prostate-specific antigen and testosterone levels and urinary flow rates were measured. All patients filled out the International Prostate Symptom Score and Quality of Life （IPSS-QoL）, International Index of Erectile Function （IIEF） and Aging Males＇ Symptoms （AMS） scale forms. Of the patients, 23.9% had mild LUTSs, 53.3% had moderate LUTSs and 22.8% had severe LUTSs. The total testosterone level did not differ between groups. Additionally, 69.6% had ED. The presence of impotence increased with increasing LUTS severity. Symptomatic late-onset hypogonadism （AMS 〉27） was observed in 71.2% of the patients. The prevalence of severe hypogonadism symptoms increased with the IPSS scores. A correlation analysis revealed that all three questionnaire scores were significantly correlated. In conclusion, LUTS severity is an age-independent risk factor for ED and SLOH. LUTS severity and SLOH symptoms appear to have a strong link that requires etiological and biological clarification in future studies.

Profile of men＇s health in Malaysia： problems and ：hallenges

Men＇s health concerns have evolved from the traditional andrology and male sexual health to a more holistic approach that encompasses male psychological, social and physical health. The poor state of health in men compared to their female counterparts is well documented. A review of the epidemiological data from Malaysia noted a similar trend in which men die at higher rates in under 1 and above 15 years old groups and most disease categories compared to women. In Malaysia, the main causes of death in men are non-communicable diseases and injuries. Risk factors, such as risk-taking behaviour, smoking and hypertension, are prevalent and amenable to early interventions. Erectile dysfunction, premature ejaculation and prostate disorders are also prevalent. However, many of these morbidities go unreported and are not diagnosed early; therefore, opportunities for early intervention are missed. This reflects poor health knowledge and inadequate health-care utilisation among Malaysian men. Their health-seeking behaviour has been shown to be strongly influenced by family members and friends. However, more research is needed to identify men＇s unmet health-care needs and to develop optimal strategies for addressing them. Because the Malaysian population is aging and there is an increase in sedentary lifestyles, optimizing men＇s health will remain a challenge unless effective measures are implemented. The existing male-unfriendly health-care system and the negative influence of masculinity on men＇s health behaviour must be addressed. A national men＇s health policy based on a male-friendly approach to health-care delivery is urgently needed to provide a framework for addressing these challenges.

Observation on lower urinary tract symptoms and erectile dysfunction in Chinese middle-aged men

Aim: To observe the incidence of lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in Chinese middle-aged men in Shanghai. Methods: In annual medical physical examination, 681 Chinese men over 50 years old were evaluated. Each men completed an International Prostate Symptoms Score (IPSS), Quality of Life Assessment (QoL) and International Index for Erectile Funtion (IIEF-5). Results: The incidence of moderate-severe LUTS (IPSS ≥ 8) in the age group 50 - 59, 60 - 69 and above 70 was 19.1 %, 30.3 % and 36.8 % respectively, while the ED incidence was 82.5 %, 88.0 % and 96.6 % respectively. The ED incidence in the mild (IPSS: 0-7), moderate (IPSS: 8-19) and severe LUTS (IPSS:20-35) groups were 71.8 %, 92.4 % and 96.4 % respectively. Conclusion: The incidence of LUTS and ED in Chinese middle-aged men is high and there is a significant correlation between the LUTS severity and the incidence of ED.

Erectile dysfunction as a predictor of asymptomatic coronary artery disease in elderly men with type 2 diabetes

1 Introduction Erectile dysfunction （ED） and coronary artery disease （CAD） are closely linked, as both conditions share the same cardiovascular risk factors. Indeed, these risk factors can determine endothelial dysfunction that represents the common underlying mechanism of both ED and CAD. The prevalence of ED is about three-fold higher among diabetic patients than in the general population and a higher prevalence of CAD has been observed in people with diabetes when compared to non-diabetic subjects.Some studies showed that ED can be a powerful marker of silent CAD and a strong predictor of cardiovascular events in apparently uncomplicated type 2 diabetic patients Therefore ED is now considered as a sentinel symptom of silent CAD, as ED often precedes the onset of myocardial ischemia itself by many years.

Differences in Male Climacteric Symptoms and Lifestyle Depending on the Duration of Working among Rotating Night Shift Workers

Background: There are various health problems in rotating shift workers. There have been few studies on the associations of male climacteric symptoms with duration of working and lifestyle. Objective: The aim of this study was to determine the differences in male climacteric symptoms depending on the number of working years and to determine whether lifestyle habits differ depending on the number of working years in rotating shift workers. Methods: We collected participant’s data from the manufacturing companies in Japan during the period from March to May in 2017. We conducted a self-administered questionnaire survey in 1561 male rotating night shift workers. Male climacteric symptoms were evaluated by using the Aging Males’ Symptoms (AMS) rating scale. We analyzed 636 rotating shift workers aged over 40 years old whose all AMS data was collected. Results: A significant difference in psychological AMS score was found between men who had worked for 10 - 19 years (9.4 ± 3.9) and men who had worked for more than 40 years (7.6 ± 3.0) (p = 0.011). Sexual functional AMS score significantly differed depending on the number of working years (less than 10 years: 8.1 ± 3.9, 10 - 19 years: 9.8 ± 4.1, 20 - 29 years: 7.9 ± 3.3, 30 - 39 years: 9.3 ± 3.5, more than 40 years: 9.3 ± 3.5) (p < 0.001). The proportion of workers with a balanced meal intake was significantly lower in men who had worked for less than 10 years and the proportions of such workers were significantly higher in men who had worked for 10 - 19 years and for more than 40 years. The proportions of men who did not drink alcohol were high in men who had worked for less than 10 years and 20 - 29 years and low in men who had worked more than 30 years. Conclusion: Psychological AMS score and sexual functional AMS score are significantly different among the 5 groups according to the number of working years on rotating shift. In addition, well-balanced diet on day shift and reduction of alcohol drinking is a related-factor for long-term rotating night shift workers.

Depressive males have higher odds of lower urinary tract symptoms suggestive of benign prostatic hyperplasia:a retrospective cohort study based on propensity score matching

Lower urinary tract symptoms suggestive of benign prostate hyperplasia(LUTS/BPH)and depression are both increasing in Chinese aging males.However,the relationship still remains unknown.To explore their relationship,a retrospective cohort study based on propensity score matching(PSM)was conducted by analyzing the China Health and Retirement Longitudinal Study dataset.After data cleaning,a total of 5125 participants were enrolled and subjected to PSM;1351 pairs were matched and followed for 2 years.Further logistic regression and restricted cubic spline(RCS)were performed to evaluate,model and visualize the relationship between depression and LUTS/BPH.Moreover,subgroup analyses and sensitivity analyses were adopted to verify the robustness of the conclusions.Before PSM,depressive patients showed higher odds of LUTS/BPH in all three models adjusting for different covariates(P<0.001).After PSM,univariate logistic regression revealed that depressive patients had higher risks for LUTS/BPH than participants in the control group(odds ratio[OR]=2.10,P<0.001).The RCS results indicated a nonlinear(P<0.05)and inverted U-shaped relationship between depression and LUTS/BPH.In the subgroup analyses,no increased risks were found among participants who were not married or cohabitating,received an education,had an abnormal body mass index(<18.5 kg m−2 and≥28 kg m−2),slept more than 6 h,did not smoke,and drank less than once a month(all P>0.05).The results of sensitivity analyses indicated identical increased risks of LUTS/BPH in all four models(all P<0.001).In conclusion,depression enhances the risks of LUTS/BPH in aging males.

Enhanced recovery after surgery in transurethral surgery for benign prostatic hyperplasia

Enhanced recovery after surgery(ERAS)measures have not been systematically applied in transurethral surgery for benign prostatic hyperplasia(BPH).This study was performed on patients with BPH who required surgical intervention.From July 2019 to June 2020,the ERAS program was applied to 248 patients,and the conventional program was applied to 238 patients.After 1 year of follow-up,the differences between the ERAS group and the conventional group were evaluated.The ERAS group had a shorter time of urinary catheterization compared with the conventional group(mean±standard deviation[s.d.]:1.0±0.4 days vs 2.7±0.8 days,P<0.01),and the pain(mean±s.d.)was significantly reduced through postoperative hospitalization days(PODs)0-2(POD 0:1.7±0.8 vs 2.4±1.0,P<0.01;POD 1:1.6±0.9 vs 3.5±1.3,P<0.01;POD 2:1.2±0.7 vs 3.0±1.3,P<0.01).No statistically significant difference was found in the rate of postoperative complications,such as postoperative bleeding(P=0.79),urinary retention(P=0.40),fever(P=0.55),and readmission(P=0.71).The hospitalization cost of the ERAS group was similar to that of the conventional group(mean±s.d.:16927.8±5808.1 Chinese Yuan[CNY]vs 17044.1±5830.7 CNY,P=0.85).The International Prostate Symptom Scores(IPSS)and quality of life(QoL)scores in the two groups were also similar when compared at 1 month,3 months,6 months,and 12 months after discharge.The ERAS program we conducted was safe,repeatable,and efficient.In conclusion,patients undergoing the ERAS program experienced less postoperative stress than those undergoing the conventional program.

Testosterone and its metabolites： differential associations with cardiovascular and cerebrovascular events in men

As men grow older, circulating testosterone declines while the incidence of cardiovascular disease increases. Thus, the role of sex hormones as biomarkers, and possibly contributing factors to clinical manifestations of cardiovascular disease in the increasing demographic of aging men, has attracted considerable interest. This review focuses on observational studies of endogenous androgens, namely circulating testosterone and dihydrotestosterone, which have examined their associations with cardiovascular events such as myocardial infarction and stroke. Studies which have examined the associations of endogenous estrogens, namely circulating estradiol, with these outcomes are also discussed. In large prospective cohort studies of predominantly middle-aged and older men, lower circulating testosterone consistently predicts higher incidence of cardiovascular events. Of note, both lower circulating testosterone and lower dihydrotestosterone are associated with higher incidence of stroke. These associations are less apparent when myocardial infarction is considered as the outcome. Results for estradiol are inconsistent. Lower circulating testosterone has been shown to predict higher cardiovascular disease-related mortality, as has lower circulating dihydrotestosterone. It is possible that the relationship of circulating androgens to cardiovascular events or mortality outcomes may be U-shaped rather than linear, with an optimal range defining men at lowest risk. Epidemiological studies are observational in nature and do not prove causality. Associations observed in studies of endogenous androgens need not necessarily translate into similar effects of exogenous androgens. Rigorous randomized controlled trials are needed to clarify the effects of testosterone treatment on cardiovascular risk in men.