Alvaro Morales

ANDROPAUSE: A MISNOMER FOR A TRUE CLINICAL ENTITY

PURPOSEnA progressive decrease in androgen production is common in males after middle age. The resulting clinical picture has been erroneously named male menopause or andropause. A more appropriate designation is androgen decline in the aging male (ADAM). The syndrome is characterized by alterations in the physical and intellectual domains that correlate with and can be corrected by manipulation of the androgen milieu. We review the epidemiological aspects of aging and endocrinological manifestations of ADAM, and provide recommendations for treatment and monitoring of these patients.nnnMATERIALS AND METHODSnWe performed MEDLINE, Pubmed, Current Contents and Pharmaceutical Abstracts searches of relevant peer reviewed publications on andropause, male climacteric, adult hypogonadism and aging. In addition, conference proceedings were researched to provide a more complete review of the literature. Information was scrutinized and collated, and contributory data were reviewed and summarized.nnnRESULTSnADAM is a clinical entity characterized biochemically by a decrease not only in serum androgen, but also in other hormones, such as growth hormone, melatonin and dehydroepiandrosterone. Clinical manifestations include fatigue, depression, decreased libido, erectile dysfunction, and alterations in mood and cognition.nnnCONCLUSIONSnThe onset of ADAM is unpredictable and its manifestations are subtle and variable, which has led to a paucity of interest in its diagnosis and treatment. Urological practice commonly includes a large proportion of men older than 50 years. Therefore, it is important for urologists to recognize the manifestations of and be familiar with evaluations necessary to document ADAM as well as its treatment and monitoring.

Facts and Controversies on the Application of Penile Tumescence and Rigidity: Recording for Erectile Dysfunction

In the 1960s, Fisher et al1 and Karaean et al2 independently developed a systematic approach to assess nocturnal penile tumescence and rigidity (NPTR) as measurements to use in studying penile erection in sleep. This was the first objective measurement of penile erection with the specific goal of assessing sexual function. In many ways, it opened the field to the possibility of scientific study of human sexuality. Measuring erectile capability has since been used in other applications, such as comparing the efficacy of therapies for erectile dysfunction (drugs or surgery), the effects of disease and drugs, and assessing the parameters of erectile function. With NPTR measurements it is now possible to improve the understanding of the fundamental mechanisms of penile rigidity and the physical properties of the flaccid and erect penis.

Hormonal Evaluation and Treatment

Hypogonadism is a problem that has been known about for millennia, both as an endocrine disease and as an age-related phenomenon. Normal aging results in changes in androgen status and alterations in feedback sensitivities, decline in synthetic capacity, changes in serum availability, aging of responder cells, and interaction with other hormone and regulatory systems (e.g., dihydroepiandrosterone, growth hormone, melatonin, leptin). There are significant variations in how hypogonadism develops in terms of timing, the systems involved, and the extent of the changes. Genetic factors may play a part in these variations.

Nonsurgical Treatments for Erectile Dysfunction: Oral, Topical, Intracavernous, and Vacuum Devices

The availability of vasoactive drugs for intracavernosal injection has been one of the most significant milestones in the treatment of male erectile dysfunction. It has allowed meticulous investigation of the physiologic process of penile erection and opened up viable therapeutic alternatives for the patient with mild to moderate alterations at the level of the corpora. Equally important, the advent of injectable vasoactive drugs has permitted large strides in our understanding of the physiologic mechanisms of erection. The elucidation of many of those mechanisms at the cellular level has permitted the development of therapeutic strategies based on sound pharmacologic principles. We are getting closer to the availability of effective, noninvasive medications. This accomplishment is not the result of fortuitous progress: it is the culmination of dedicated and applied research to an area that for decades has remained in the background of medical interest.