Male hypogonadism arises from a deficiency in testosterone secretion that may occur naturally with increasing age, or as a result of malfunction of the hypothalamus, pituitary gland or testes. Tostran (also known as Fortigel, Itnogen and Tostrex) is a metered-dose gel formulation of 2% testosterone that was recently developed to treat male hypogonadism and to overcome the disadvantages exhibited by some testosterone formulations.
There has for many years been confusion and debate as to whether the male menopause (now known as the andropause) exists. Such debate stems mainly from use of the lay term ‘male menopause’, which was coined in the 1980s to describe a syndrome of symptoms that, in part, resemble those of the female menopause. Those who question the existence of the male menopause have asked, quite correctly: ‘How can men have a menopause?’ After all, the word ‘menopause’ means the cessation of periods! Introduction of the term menopause in relation to men was, quite frankly, ridiculous, and had a more appropriate term been used from the start, then there would perhaps be less debate and more acceptance.
Hypoandrogenaemia (hypogonadism, hypotestosteronaemia) may be a common accompanying factor in men with the metabolic syndrome and together they may be considered as a specific entity, the hypoandrogen–metabolic (HAM) syndrome. Both hypoandrogenaemia and the metabolic syndrome are common and their prevalence increases with age. Hypoandrogenaemia may be an aetiological factor in the development of the metabolic syndrome and both share similar co-morbid factors. Obesity, low androgen levels and the metabolic syndrome are common findings in Western middle-aged and elderly men and place them at an increased risk for type 2 diabetes, cardiovascular and coronary heart disease. In the absence of contraindications, men with HAM and symptoms of androgen deficiency may be managed by testosterone replacement therapy along with weight reduction and other measures to normalise glucose, insulin, lipid and blood pressure control.
Testosterone deficiency syndrome (TDS) has a significant impact on the quality-of-life of those affected. As noted in the other articles in this issue, clinical trials have shown that testosterone replacement therapy (TRT) can improve these signs and symptoms which include libido, erectile dysfunction, fatigue, muscle weakness, bone mineral density and mood changes.
Recently, it has been proposed that hypoandrogenaemia (hypogonadism, hypotestosteronaemia) may be a common accompanying factor in men with the metabolic syndrome (insulin resistance, Reaven’s syndrome or syndrome X). When they are present together they may be considered as a specific entity, the hypoandrogen-metabolic (HAM) syndrome.
Overweight men with erectile dysfunction are often referred to urologists. Such men will often be found to have the metabolic syndrome that often coexists with hypoandrogenaemia as the so-called ‘hypoandrogen-metabolic (HAM) syndrome’.
Men’s health has become an important medical, social and political issue. On average, men die 5 years younger than women, and some reasons for this ‘gender gap’ are deeply entrenched and unhealthy patterns of male behaviour. In this review, we set out ways by which the urologist can interact positively with their male patients to increase their longevity and enhance their quality of life.
The presence of prostate cancer is an absolute contraindication to testosterone therapy, as was recognised long before the era of PSA testing. Serum PSA levels relate to prostate cancer risk, but PSA expression is itself androgen-dependent.
Prescription sales of testosterone have risen considerably over the last decade and are likely to continue to grow as further preparations become available. Testosterone promotes existing prostate cancer; however, concern does exist as to whether or not testosterone therapy induces prostate cancer. The aim of this article is to review the evidence for such a link.
Interest in testosterone replacement therapy (TRT) continues to increase, with prescription sales of testosterone in the USA growing by 500% since 1993.
The term “male menopause” is inappropriate because it suggests a sudden drop in sex hormones such as occurs in women in the perimenopausal state. It is not an inevitability but may occur mainly in middle-aged and elderly men when testosterone production and plasma concentrations fall.
Be it “andropause” or “climacteric,” do men undergo some kind of hormonal change akin to the female menopause? Adding to the growing debate about men’s health, Duncan Gould and Richard Petty argue that some patients need investigation and treatment with testosterone. Howard Jacobs, however, is not convinced.
Since May of 1998, we have prescribed Viagra (sildenafil citrate) to 442 patients presenting with male erectile dysfunction (MED). Men were aged between 21 and 84 y. All were seen by a physician with experience in managing MED. All patients had a comprehensive consultation and full physical examination. Blood samples were analysed for full blood count, biochemistry, liver and kidney function, plasma glucose, PSA, testosterone and SHBG levels. Prolactin measurements were made if testosterone levels were below 7 nmol/l.