Rachel E. Williams

Menopause-specific questionnaire assessment in US population-based study shows negative impact on health-related quality of life

OBJECTIVE To use the Menopause-Specific Quality of Life Questionnaire (MENQOL) to assess the impact of menopausal symptoms on health-related quality of life in a large US population-based study. METHODS Participants were recruited from the US population through random-digit-dialing and probability sampling. Analyses included 2703 postmenopausal women 40-65 years old in our Menopause Epidemiology Study. Respondents answered a 30-min questionnaire, including the MENQOL. RESULTS Scores for each domain were: vasomotor: 3.2+/-2.2; psycho-social: 3.3+/-1.8; physical: 3.5+/-1.5; sexual: 2.9+/-2.1. There were significant differences in the MENQOL scores by age, smoking, exercise, education, employment status and BMI. Women aged 60-65 years (p<0.0001), with a bachelors degree or higher level of education (p<0.0001), who exercised at least 3 days a week (p<0.0001), who had never smoked (p<0.0001), with a body mass index < or =25kg/m(2) (p<0.0001), and who had significantly lower scores indicating better quality of life. Hot flashes affected work (46.0%), social activities (44.4%), leisure activities (47.6%), sleep (82.0%), mood (68.6%), concentration (69.0%), sexual activity (40.9%), total energy level (63.3%) and overall quality of life (69.3%). CONCLUSION Symptoms experienced during menopause and socio-demographic characteristics affect the quality of life in postmenopausal women. Hot flashes impact the daily activities of most postmenopausal women, especially those with more frequent/severe symptoms. Treatments that safely and effectively treat these symptoms could improve quality of life among postmenopausal women.

Correlates of low testosterone and symptomatic androgen deficiency in a population-based sample.

CONTEXT Risk factors for low testosterone and symptomatic androgen deficiency (AD) may be modifiable. OBJECTIVE Our objective was to examine demographic, anthropometric, and medical correlates of low testosterone and symptomatic AD. DESIGN Data were used from the Boston Area Community Health Survey, an epidemiological study conducted from 2002-2005. SETTING Data were obtained from a community-based random sample of racially and ethnically diverse men. PATIENTS OR OTHER PARTICIPANTS Data were available for 1822 men. MAIN OUTCOME MEASURES Multivariate logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for associations of covariates with 1) low testosterone and 2) symptomatic AD. The operational definition of low testosterone was serum total testosterone less than 300 ng/dl and free testosterone less than 5 ng/dl; symptomatic AD was defined as the additional presence of symptoms: any of low libido, erectile dysfunction, or osteoporosis or two or more of sleep disturbance, depressed mood, lethargy, or diminished physical performance. RESULTS Factors associated with low testosterone included age (OR = 1.36; 95% CI= 1.11-1.66, per decade), low per-capita income (

Frequency and severity of vasomotor symptoms among peri- and postmenopausal women in the United States

6000 or less per household member vs. more than

The Natural History of Symptomatic Androgen Deficiency in Men : Onset, Progression, and Spontaneous Remission

30,000; OR = 2.86; 95% CI = 1.39-5.87), and waist circumference (per 10-cm increase; OR = 1.75; 95% CI = 1.45-2.12). Only age (OR = 1.36; 95% CI = 1.04-1.77), waist circumference (OR = 1.88; 95% CI = 1.44-2.47), and health status (OR = 0.21; 95% CI = 0.05-0.92, excellent vs. fair/poor) were associated with our construct of symptomatic AD. Of all variables, waist circumference was the most important contributor in both models. CONCLUSIONS Waist circumference is a potentially modifiable risk factor for low testosterone and symptomatic AD. Manifestation of symptoms may be a consequence of generally poor health status.

Association Between Testosterone and Estradiol and Age-Related Decline in Physical Function in a Diverse Sample of Men

Objective To describe characteristics of vasomotor symptoms, specifically daily frequency and severity, among women 40–65 years old in the United States (US). Design A survey was completed by a nationally representative sample of 4402 US women aged 40–65 years old. A questionnaire focusing on menopausal symptoms was administered online in April 2005. Results The prevalence of vasomotor symptoms was 79% in peri- and 65% in postmenopausal women. Women with daily vasomotor symptoms had an average of 2.5 very mild/mild, 2.6 moderate, 2.5 severe, and 1.4 very severe daytime hot flushes in a typical day. Women with night sweats every night had an average of 2.4 moderate, 3.2 severe, and 2.7 very severe night sweats in a typical night. Overall, 9% of peri- and 7% of postmenopausal women reported 7+ moderate to very severe vasomotor symptoms in a typical day. Although some women reported that symptoms were worse in the evening and in the summer, many women reported they were consistent, both throughout the day and throughout the seasons of the year. Conclusions The Menopause Epidemiology Study builds upon existing literature by providing data on daily frequency and severity of vasomotor symptoms. There are many women with frequent and severe vasomotor symptoms who may benefit from treatment.

Treatment of Symptomatic Androgen Deficiency: Results From the Boston Area Community Health Survey

OBJECTIVES: To describe the onset, progression, and remission of symptomatic androgen deficiency (SAD) using longitudinal data from the Massachusetts Male Aging Study (MMAS).

Physical function and health-related quality-of-life in a population-based sample.

OBJECTIVES: To examine the association between aging and physical function in men by testing a theoretically based model of aging, hormones, body composition, strength, and physical function with data obtained from men enrolled in the Boston Area Community Health/Bone (BACH/Bone) Survey.

Association Between Testosterone and Estradiol and Age-Related Decline in Physical Function in a Diverse Sample of Men: AGING, HORMONES, AND PHYSICAL FUNCTION IN MEN

BACKGROUND Despite the aging of the US population and increasing sales of prescription testosterone, treatment patterns for androgen deficiency (AD) are poorly understood. We describe patterns and correlates of testosterone treatment in community-dwelling men. METHODS The Boston Area Community Health Survey is an observational study of a population-based random sample of racially and ethnically diverse men representative of Boston, Massachusetts. Data collected by in-person interview from April 2002 to June 2005 included health status, socioeconomic status, access to medical care, and use of prescription medications. A venous blood sample was collected. The operational definition of untreated AD was serum total testosterone level less than 300 ng/dL (to convert to nanomoles per liter, multiply by 0.0347) and free testosterone level less than 5 ng/dL, and the presence of at least 1 specific symptom (low libido, erectile dysfunction, or osteoporosis) or 2 or more less-specific symptoms (sleep disturbance, depressed mood, lethargy, or diminished physical performance) and not using prescription testosterone. Any man who was using testosterone was considered to have treated AD. RESULTS Data were available for 1486 Boston Area Community Health Survey participants (mean age, 46.4 years; age range, 30-79 years). A total of 5.5% (95% confidence interval, 3.5-8.5) men met the criteria for having untreated, symptomatic AD, and 0.8% (95% confidence interval, 0.4-1.4) met the criteria for having treated AD. Considering all cases, the proportion treated was 12.2%. Men with untreated AD seemed to have adequate access to care. CONCLUSIONS Under our assumptions, a large majority (87.8%) of 97 men in our groups with AD were not receiving treatment despite adequate access to care. The reasons for this are unknown but could be due to unrecognized AD or unwillingness to prescribe testosterone therapy.

ASSOCIATION OF TESTOSTERONE AND ESTRADIOL WITH AGE-RELATED DECLINES IN PHYSICAL FUNCTION IN A DIVERSE SAMPLE OF MEN

Background. It is of interest to understand whether impaired physical function is associated with health-related quality-of-life (HRQOL). We examined upper and lower body physical function and its relationship with two domains of HRQOL among men. Methods. We conducted a population-based observational study of musculoskeletal health among Boston, MA residents, the Boston Area Community Health/Bone Survey. Participants were 1219 randomly-selected Black, Hispanic, and White males (30–79 years). Upper body function was measured using hand grip strength, while lower body function was measured by combining a timed walk and a chair stand test. HRQOL was measured using the physical (PCS-12) and mental health (MCS-12) component scores of the SF-12. Multivariate linear regression models were used to estimate the association between poor function and HRQOL. Results. There was a significant association of poor upper body physical function with the MCS-12 (β coefficient: −4.12, p = 0.003) but not the PCS-12 (β coefficient: 0.79, p = 0.30) compared to those without poor function. Those with poor lower body physical function had significantly lower PCS-12 scores (β: −2.95, p = 0.007), compared to those without poor function, but an association was not observed for MCS-12 scores. Conclusions. Domains of physical function were not consistently related to domains of HRQOL.

Prevalence of symptomatic androgen deficiency in men.

OBJECTIVES: To examine the association between aging and physical function in men by testing a theoretically based model of aging, hormones, body composition, strength, and physical function with data obtained from men enrolled in the Boston Area Community Health/Bone (BACH/Bone) Survey.