Table 2 - uploaded by Bruno Lunenfeld
Content may be subject to copyright.
Source publication
With prolonged life expectancy, men and women can expect to live one-third of their lives with some form of hormone deficiency. The ageing male, in particular, has the added problem of developing urological diseases, such as benign prostatic hyperplasia (BPH), prostate cancer, continence disorders and erectile dysfunction. When discussing age-relat...
Citations
... Of note, the GH/IGF-1 axis activates the phosphatidylinositol 3 kinase/protein kinase B (AKT) pathway, thereby increasing muscle protein synthesis (MPS) through activation of mammalian target of rapamycin (mTOR) signaling while decreasing muscle protein breakdown (MPB) via inactivation of forkhead box O (FOXO) transcription factors (287). Aging also results in decreases in serum testosterone and adrenal androgens (a phenomenon known as "andropause" in men) (90,249). Testosterone increases muscle mass and function through its stimulating effect on protein synthesis and intramuscular IGF-1 mRNA, and also through a decreasing effect on the inhibitory IGF binding protein 4 (137). ...
Societies are progressively aging, with the oldest old (i.e., those aged >80–85 years) being the most rapidly expanding population segment. However, advanced aging comes at a price, as it is associated with an increased incidence of the so‐called age‐related conditions, including a greater risk for loss of functional independence. How to combat sarcopenia, frailty, and overall intrinsic capacity decline in the elderly is a major challenge for modern medicine, and exercise appears to be a potential solution. In this article, we first summarize the physiological mechanisms underlying the age‐related deterioration in intrinsic capacity, particularly regarding those phenotypes related to functional decline. The main methods available for the physical assessment of the oldest old are then described, and finally the multisystem benefits that exercise (or “exercise mimetics” in those situations in which volitional exercise is not feasible) can provide to this population segment are reviewed. In summary, lifetime physical exercise can help to attenuate the loss of many of the properties affected by aging, especially when the latter is accompanied by an inactive lifestyle and benefits can also be obtained in frail individuals who start exercising at an advanced age. Multicomponent programs combining mainly aerobic and resistance training should be included in the oldest old, particularly during disuse situations such as hospitalization. However, evidence is still needed to support the effectiveness of passive physical strategies including neuromuscular electrical stimulation or vibration for the prevention of disuse‐induced negative adaptations in those oldest old people who are unable to do physical exercise.
... Сущность этих выраженных изменений может быть отражена термином «возрастной десинхроноз» [8,9]. Одной из первопричин возрастного десинхроноза является закономерное снижение с возрастом продукции мелатонина, служащего ведущим гуморальным регулятором биологических часов, хронобиотиком с широким спектром физиологического действия [10][11][12][13][14][15][16][17]. ...
Purpose of this investigation was to study the circadian biologic rhythm dysregulation of intraocular pressure (IOP), blood pressure (BP), and heart rate (HR) in primary open-angle glaucoma (POAG) patients of different age groups. Objectives: to reveal the desynchronosis pattern of biologic rhythm parameters in POAG patients, to study the influence of peptide bioregulatory complex on the synchronization of chosen parameters, to investigate correction possibilities from the perspective of the optic nerve tolerance enhancement, ischemia decrease and ocular perfusion improvement.
Materials and methods. At the first stage, we performed a representative selection of patients with BP, HR and IOP dysregulation among POAG patients and subjects without glaucoma of corresponding age (n = 330). For mathematic justification of the desynchronosis identification, we used cosinor-analysis of circadian changes of functional indices. At the second stage, we performed a randomized study with parallel comparison groups masked for the investigator estimating the results. Patients with revealed desynchronosis (n = 56) were randomly divided into two groups for comparison. The main group consisted of 27 patients who, in addition to systemic and local pressure-lowering therapy, received 1 tablet of epifamin (Longvi-Farm, Russia) 3 times a day for 30 days; сortexin (Geropharm, Russia) 10 mg daily for 10 days; retinalamin (Geropharm, Russia) 5 mg daily as peribulbar injections for 10 days. 29 control group patients received traditional treatment (vitamins, spasmolytics, antioxydants) together with local and systemic pressure-lowering therapy. In compared groups, we calculated the tolerant pressure level, investigated the dynamics of retinal sensitivity mean deviation (MD), registrated the oscillatory potentials (OP) with the OP index calculation.
Results. In elderly patients with glaucoma, significant changes of the temporal order of physiological parameters were found (deviation of IOP daily rhythm curves, systolic blood pressure (SBP), diastolic blood pressure (DBP), and hemodynamic indices).
Conclusion. Through hemodynamic, nootropic, neurotrophic effects of the investigated bioregulatory peptide complex, the optic nerve tolerance to the stress influence of IOP, SBP and DBP asynchronous fluctuations increased, and ocular perfusion enhanced.
... The relationship between testosterone levels and PCa is controversial. Some authors find that PCa is associated either with low or high testosterone levels [28][29][30][31]. Even more, low TT concentrations are associated with higher severity and lower differentiation of prostatic tumors [32,33]. ...
Objectives:
To assess sex hormones, leptin and insulin-resistance in men with prostate cancer (PCa) and benign prostatic hyperplasia (BPH) and to study associations between androgens and histologic score of prostate tissue in PCa.
Subjects and methods:
Two hundred ten men older than 45 years selected from 2906 participants of a population screening for PCa were studied: 70 with PCa, 70 with BPH and 70 controls (CG), matched by body mass index and age. Insulin, IGF-1, PSA, leptin, total, free (fT) and bioavailable testosterone (bT) and estradiol were measured. Each group was subdivided into two subgroups considering the presence of metabolic syndrome (MS); androgens and leptin levels were analyzed in the subgroups.
Results:
Prostate cancer and BPH patients presented higher total, fT and bT levels than CG. IGF-1, insulin and HOMA index were higher in BPH than in the other two groups. PCa presented higher leptin [median (range) 6.5 (1.3-28.0) versus 4.8 (1.1-12.3) ng/ml; p < 0.01] and estradiol [median (range) 37.0 (20-90) versus 29.0 (20-118) pg/ml; p = 0.025] levels than CG. After dividing men considering the presence of MS, leptin was higher and total testosterone was lower in MS patients in all the groups.
Conclusions:
It was observed a coexistence of an altered hormone profile with increased sex hormones and leptin in PCa patients, in accordance with the new perspective of PCa pathogenesis.
... [1] Changes in the body mass index, osteoporosis, sleep and mood disorders are correlated with hormonal changes in the ageing male. [26] Testosterone, which is the major circulating androgen in male, shows an age -related decline in the ageing male. [7] The age -related changes in reproductive hormones in men are not precipitous as in women. ...
... leva a um aumento do risco de aterosclerose, ocorrendo também perda mais acentuada de tecido ósseo, com osteoporose (Riggs. 2002). Também no homem ocorre diminuição da produção de testosterona, estradiol, dihidroepiandrostenediona e sulfato de dihidroepiandrostenediona, com aumento das concentrações de SHBG (Sex hormone binding globulin), LH e FSH (Schulman & Lunenfeld. 2002). As concentrações de GH e de IGF-I também se encontram diminuídas, sendo que neste caso a sua síntese diminui devido a alterações a nível da produção hipotalâmica de GHRH e de somatostatina (Muller et al. 2002). No doente idoso também é mais frequente a diminuição da tolerância à glicose, principalmente por insulinorresistência (Perry. ...
... 3.1.1. Sexual, psychosocial, and medication history-The sexual symptoms of androgen insufficiency are varied and include decreased sexual interest; diminished erectile quality, particularly of nocturnal erections; muted, delayed or absent orgasms; decreased genital sensation; and reduced sexual pleasure [82,83,86,[88][89][90]. In addition, sexual dysfunction may affect the patient's self-esteem, coping ability, and occupational and social roles [4]. ...
... In addition, sexual dysfunction may affect the patient's self-esteem, coping ability, and occupational and social roles [4]. Androgen insufficiency is associated with changes in mood, diminished well-being, blunted motivation, changes in spatial orientation, reduced intellectual ability, fatigue, depression, and anger/irritability [82,83,86,[88][89][90]. ...
Androgens are essential for the development and growth of the penis, and they regulate erectile physiology by multiple mechanisms. Our goal is to provide a concise overview of the basic research and how this knowledge can be translated into a new clinical paradigm for patient management. In addition, this new paradigm may serve as a basis for stimulating constructive debate regarding the use of testosterone in men, and to promote new, innovative basic and clinical research to further understand the underlying mechanisms of androgen action in restoring erectile physiology.
A literature review was performed utilizing the US National Library of Medicine's PubMed database.
On the basis of evidence derived from laboratory animal studies and clinical data, we postulate that androgen insufficiency disrupts cellular-signaling pathways and produces pathologic alterations in penile tissues, leading to erectile dysfunction. In this review, we discuss androgen-dependent cellular, molecular, and physiologic mechanisms modulating erectile function in the animal model, and the implication of this knowledge in testosterone use in the clinical setting to treat erectile dysfunction. The new clinical paradigm incorporates many of the consensed points of view discussed in traditional consensed algorithms exclusively designed for men with androgen insufficiency. There are, however, novel and innovative differences with this new clinical paradigm. This paradigm represents a fresh effort to provide mandatory and optional management strategies for men with both androgen insufficiency and erectile dysfunction.
The new clinical paradigm is evidence-based and represents one of the first attempts to address a logical management plan for men with concomitant hormonal and sexual health concerns.
... The hormonal milieu in the body is not only a reflection of age-related changes but is also impacted by concurrent medical illnesses and medications. Since normal sexual function in men involves a complex interplay of psychological, neurologic, vascular, and endocrine factors [37], it is not unexpected to see that a higher proportion of men with ED in our study population had abnormal hormone levels. ...
... As noted before, the prevalence of ED increases with age. SHBG is also increased in aging men [33,37]. The negative correlation between SHBG and erectile function thus becomes obvious. ...
Background
Depression and erectile dysfunction (ED) are common in aging and the two conditions often co-exist. These conditions have been shown to be associated with hormonal changes in men. This paper examines the association between depression, ED, and hormonal status of men aged above 50 years in the Klang Valley, Malaysia.Methods
Five hundred men aged 50 years and above were randomly selected via the electoral roll and invited to participate in a community-based study on men's health: 351 men responded. Respondents were interviewed individually based on a self-developed questionnaire, which included information on socio-demographic data. Erectile function was measured using the International Index for Erectile Function-5 (IIEF-5) and depression was measured using the 15 item Geriatric Depression Scale (GDS-15).ResultsSixty-nine percent of the men were diagnosed with ED. Mean GDS score was 3.33 (SD = 3.29). Nineteen percent (n = 67) of the men had abnormal levels of testosterone (≤11 nmol/l) and this comprised 73% of men with ED (n = 49) and 27% of men without ED (n = 18). There was no significant association between testosterone level and ED (χ2 = 0.68, p = 0.41). Significant association was found between depression (GDS ≥ 5) and men with ED (χ2 = 6.07, p = 0.014). Sex hormone binding globulin and luteinising hormone were negatively correlated with erectile function. Results of the multiple linear regression showed that age and depression are predictors of erectile function.Conclusion
Depression and ED should be screened for when either exists in the male patient and treatment directed accordingly.
... Partial endocrine deficiencies of aging are associated with a decrease in the peripheral levels of testosterone (T), dehydroepiandrosterone (DHEA), DHEA sulfate (DHEA-S), growth hormone, insulin-like growth factor-1 (IGF-1), estradiol (E 2 ), and melatonin. Osteoporosis is one of the possible clinical conditions associated with these hormonal changes [6]. However, hormonal changes that may be associated with age-related bone loss in men is not clear [2]. ...
To evaluate the role of endogenous sex steroids on bone mineral density (BMD) in healthy Turkish men.
Serum total testosterone (TT), free testosterone (FT), dehydroepiandrosterone sulfate and estradiol levels were assayed in 174 healthy men of 240 volunteers, aged 22-76 years. Dual-energy X-ray absorptiometry was used to measure the BMD (g/cm(2)) of lumbar spine, femoral neck and non-dominant proximal and distal radius-ulna sites. Linear regressions were conducted using each BMD site as the dependent variable and each sex steroid as the independent variable. Four models were run for each bone site and sex steroid; crude, age-adjusted, adjusted for age and body mass index (BMI), and adjusted for age, BMI and cigarette-smoking.
The mean age and BMI of men enrolled in the study were 47.7 +/- 13.7 years and 26.9 +/- 3.6 kg/m(2). Log of FT was significantly associated with the BMD of distal forearm in all models analyzing the crude and adjusted effects. Dehydroepiandrosterone sulfate effect on BMD of proximal forearm came closer to the level of statistical significance when adjusted with age, BMI and cigarette-smoking. Estradiol and TT levels were not found to be associated with BMD of any sites measured.
Among the endogenous sex steroids in men, predominantly FT seems to be one of the determinants of BMD. Therefore a decrease in serum levels of testosterone in aging male or secondary causes may negatively affect BMD.
... The urologist is generally faced with a high percentage of elderly patients. The incidence of various male urological diseases and conditions, such as erectile dysfunction (ED), prostate cancer, benign prostatic hyperplasia (BPH), and androgen deficiency increases with age [10]. Since evidence suggests that partial androgen deficit, along with other factors (Fig. 1), affects a wide range of body systems, the urologists should be aware of the potential benefits and the risks of DHEA supplementation to improve and sustain quality of life and health in aging men. ...
Dehydroepiandrosterone (DHEA) has attracted considerable attention as a means against the decrements of aging. This review will summarize clinical studies evaluating DHEA as a treatment option for age-related conditions and diseases.
Literature search of PubMed documented publications and abstracts from meetings.
The collected data indicate that DHEA supplementation to counteract its gradual decrease over age is beneficiary. Positive effects on the cardiovascular system, body composition, BMD, the skin, the CNS, and the immune system have been reported. Improvement of sexual function by DHEA has been demonstrated.
Although long-term clinical trials (applying the standards of evidence-based methods) are not available at present, the consistency of the data and the extensive practical experience may justify the use of DHEA in aging men given the rules of classical endocrinology are thoroughly followed including diagnosis based on clinical picture and biochemical evidence, compliance to periodic evaluations, and individual dose adjustment to maintain serum concentrations in the physiological range of young males. Being one among other important hormonal factors, DHEA can delay and correct age-related disorders only to a certain degree.
... Some general conditions, such as muscle weakness, general frailty, osteoporosis or developing urological diseases, such as benign prostatic hyperplasia, prostate cancer, and continence disorders, are continuously increasing in incidence. Some of these conditions, which subsequently limit the quality of life in elderly men, tend to increase in frequency with advancing age and may be related to hormonal changes in the aging male, as described by Aging Male Syndrome or Partial Androgen Deficiency Syndrome [13,24]. ...
... On the other hand, ED can not be interpreted exclusively as a consequence of endocrine changes, and the exact mechanism of hormonal changes has not been clearly identified [20]. However, to improve the aging male syndrome, including bone mineral density and ED, androgen replacement therapy has been recommended [24]. ...
... Age-related clinical signs and symptoms increase with the rise in human life expectancy. ED is one of those symptoms, which is a frequent and important problem in the aging male [24]. Another important condition recently taken into consideration in aging men is bone loss, being a universal consequence of aging for both genders [29]. ...
Seventy-six of 108 random men aged 50 years or over were evaluated for erectile dysfunction with interviews of patients using the International Index of Erectile Function Form and minimal evaluation. Serum hormone concentrations were measured. Bone mineral density was measured using dual energy x-ray absorptiometry. Hormone levels did not show significance in terms of erectile dysfunction or bone mineral density results. Erectile dysfunction was determined in 57 (75%) of 76 patients. Ten (13.2%) patients had osteoporosis and 45 (59.2%) had osteopenia at the bone mineral density measurements. The distribution of bone mineral density groups relating to erectile dysfunction did not show significance. The frequencies of osteoporosis and erectile dysfunction increased with age, but the association of these conditions seems to be independent of each other and hormonal changes appear not to be the major determinants for both conditions in elderly men.
