Andropause for class

Andropause for class - Andropause Gateway Geriatric...

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Unformatted text preview: Andropause Gateway Geriatric Education Center Saint Louis University Division of Geriatric Medicine What is “andropause”? What is “andropause”? Male menopause Decline in testosterone in later years Changes that occur in older males’ health status as a result of physiological changes Araeteus the Cappadocian Hypogonadism Decreased libido Decreased energy and well being Increased pitch “For it is the semen, when possessed of vitality, which makes us to be men not well braced in limbs, hairy, well voiced, spirited, strong to think and to act, as the characteristics of men prove. For when the semen is not possessed of its vitality, persons become shriveled, have a sharp tone of voice, lose their hair and their beard, and become effeminate, as the characteristics of eunuchs prove.” Decreased muscle mass Decreased cognition Decreased beard growth Anemia Osteoporosis Visceral obesity Decreased erections and ejaculations SKOPTS Ottoman Empire Semiramis “Head of the of Assyria Blessed th Chamber” 8 Century BC introduction of idea of Eunuchs HIJRA Sun Castrates (RA) Emperor ChengZu Ming Dynasty Sun Yaoting 1902-1996 ↓ Cognition ↓ Libido Osteoporosis ↓ Strength Hypogonadism of Andropause ↓ Coronary Vasodilation ↑ Ischemic heart disease ↑ Obesity ↑ Leptin ↓ Hemoglobin TESTOSTERONE AND VIAGRA TESTOSTERONE AND VIAGRA Sildenafil (Viagra) failures can be reversed by giving testosterone to hypogonadal patients Tariq et al Clin Geriatr Med 19:539,2003 VIAGRA AND VIAGRA AND TESTOSTERONE (n=67) Shabsigh et al IIEF T­GEL +VIAGRA Erectile 5.65 Orgasmic 1.53 Desire 0.44 Satisfactio 1.21 n Overall 1.62 Total 10.44 PLACEBO +VIAGRA 2.97 0.36 0.00 0.70 P­value 0.61 4.62 0.04 0.02 0.03 0.01 0.21 0.25 TESTOSTERONE AND TESTOSTERONE AND COGNITION Low testosterone is associated with declining cognition Testosterone improves memory. Two studies showed low testosterone predicts Alzheimers disease. TESTOSTERONE AND TESTOSTERONE AND MUSCLE Testosterone = ↑ muscle size & type I & II fibers Testosterone ↑ max. muscle strength and leg power Testosterone enhances muscle synthesis Testosterone inhibits adipocyte precursors (Bhasin, Urban, Nair) Androgens May be of particular benefit for the treatment of “sarcopenic obesity” % Change in Lean Body Change % Change in Fat Mass Mass Mass 8 3 * * 4 2 2 1 0 6 Baseline Andriol 0 Month 6 Month 12 Placebo -2 -1 -6 Baseline Month 6 -3 01/03/12 01/03/12 * P < 0.0001 -8 Month 12 Placebo * -4 -2 Andriol ** * P < 0.0001 * P < 0.002 13 Functional Status and Testosterone Saint Louis University Inner City Aging Project Bioavailable Testosterone Doors -0.344 (0.024) 6m walk -0.506 (0.007) Get Up & Go -0.324 (0.039) Testosterone and Rehabilitation Bakhshi et al. JAGS 48:550, 2000 FIM 100 90 80 70 60 80 70 60 50 40 p<0.012 Baseline Disch Baseline Disch Grip strength p<0.033 Baseline Disch Baseline Disch CONTROL TESTOSTERONE Osteoporosis and Testosterone Burger H et al. Am J Epidemiol 1998;147:871 0.005 g/cm2/year ­0.005 ­0.01 9 ­5 5 64 0­ 6 65 ­6 9 70 ­74 75 ­79 >8 0 5 Poor G et al. Osteoporosis Int 1995;5:419 1000 0 ­0.015 First Hip Fracture Due to Moderate Trauma (In Men 1978­1989) Incidence per 100,000 person­years Yearly BMD Change in Men Age Group 800 Cervical Intertrochanteric 600 400 200 0 <50 50­54 55­59 60­64 65­69 70­74 75­79 80­84 >85 Age Group Mortality of Hip Fractures Poor G et al. Osteoporosis Int 1995;5:419­26 % 30 25 20 15 10 5 0 Men Women Overall <75 years >75 years **Low testosterone is associated w/minimal trauma hip fracture. ­ Stanley, JAGS 39:766,1991 ­ Jackson, Am J Med Sci 304:4, 1992 ­ Abbasi, Am J Med Sci 310:229, 1993 The Key Questions Are declining testosterone levels with aging clinically relevant? Is testosterone therapy in older persons beneficial? What risks are associated with testosterone substitution in older men? PROSTATE CANCER INCIDENCE PROSTATE CANCER INCIDENCE AND TESTOSTERONE LEVELS 1000 TESTOSTERONE 800 600 400 200 0 PIN BPH FAM. PROSTATE CA FAM. CA SPOR ADIC CA MEDIAN AGE DIAGNOSIS 30 -3 35 4 -3 40 9 -4 45 4 -4 50 9 -5 55 4 -5 60 9 -6 65 4 -6 70 9 -7 75 4 -7 80 9 -8 4 >8 5 Testosterone (ng/dl) Incidence (per 100000) 1200 age (years) Impotence in Medical Impotence in Medical Outpatients Slag et al,JAMA 249:763,1983 CAUSE Medication PERCENTAGE 25% Psychogenic 14% Secondary 9% Hypogonadism Primary Hypogonadism 10% Testosterone and Women ↑ Libido ↑ General well being ↓ Breast tenderness ↓ Headaches ↑ Bone mineral density ↑ Muscle mass ...
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This note was uploaded on 01/03/2012 for the course DIAG 717 taught by Professor Killinger during the Summer '09 term at Palmer Chiropractic.

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