Thomas Mulligan

Religious Activity Improves Life Satisfaction for Some Physicians and Older Patients

OBJECTIVE: To assess religious perceptions and activities of physicians and older patients and to determine whether religious activities are associated with life satisfaction.

Synthetic somatostatin analog (octreotide) suppresses daytime growth hormone secretion equivalently in young and older men : Preserved pituitary responsiveness to somatostatin's inhibition in aging

OBJECTIVE: To gain greater insight into the mechanisms controlling the low daytime rate of growth hormone (GH) secretion in older men.

Disorders of male sexual function

Sexuality remains an important issue in the older population. In spite of a decreased ability to achieve an erection, there is continued sexual desire. Many studies suggest that erectile dysfunction in the aged is primarily caused by age-associated chronic disease rather than normal, healthy aging. Therefore, preventive measures that are aimed at the underlying diseases should be sought. Nevertheless, effective treatment options are now available to successfully regain sexual function and thereby, improve quality of life.

Human immunodeficiency virus and hypogonadal bone disease.

We read with interest the article by Drs. Qaqish and Sims pertaining to bone disorders associated with the human immunodeficiency virus (HIV). The authors mention hypogonadism as a secondary cause of osteoporosis in HIV-infected individuals but fail to address the importance of this topic. By providing additional information, we hope that readers will understand the implications of HIV-associated endocrinopathies and their effects on bone density. Past analyses of HIV-infected men demonstrate that 30–50% are hypogonadal. 3 As disease severity progresses, so does the risk of hypogonadism. 3 Male hypogonadism is divided into two types: hypogonadotropic and hypergonadotropic hypogonadism. Men who are HIV positive have mixed hypogonadism (both types) due to HIV infection complications (e.g., weight loss, accompanying infections, Leydig cell destruction) and associated treatment regimens, ultimately diminishing appropriate hypothalamicpituitary-testicular axis responsiveness. 6 Investigators have long appreciated the risk of hypogonadal bone disease. Men with hypogonadism have lower bone mineral density (BMD) than their eugonadal counterparts. Elderly men with androgen deficiency have higher fracture risks. 12 Prostate cancer– associated androgen deprivation (after treatment with gonadotropin-releasing hormone analogues) results in deleterious BMD trends. Estrogen, one of testosterone’s metabolites, also plays a role in male BMD. Men infected with HIV have suboptimal circulating testosterone and/or estrogen concentrations, which contribute to their impaired BMD. Young (age < 30 yrs) hypogonadal HIV-infected men are at risk for not achieving peak bone mass. Androgen therapy in hypogonadal, HIVnegative men beneficially influences BMD, especially in men with lower pretreatment testosterone levels and lower baseline BMD (Table 1). Trabecular bone loss appears most sensitive to the effects of androgen deprivation. In accordance, spinal trabecular bone is highly responsive to androgen therapy. 20 Androgen replacement therapy improves a variety of male HIV-associated comorbidities. 22, 24–26 Although, to our knowledge, no data exist on the effects of androgen therapy on BMD in hypogonadal, HIVpositive men, it is plausible to expect similar results as those seen in hypogonadal, HIVnegative men. This hypothesis is supported by significant BMD improvement in eugonadal, HIVinfected individuals after androgen use.