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PubMed1993

[Cellular biology of sex steroid and clinical implication].

Advances in molecular biology contribute to additional precise knowledge of sex steroid biology. Sex steroids, estrogens, androgens, and progesterone can exert their characteristic biological effects via cellular mechanism on their targets. Sex steroids are derived from the gonads and interact with SHBG or CBG, which is located in the serum, on the plasma-membrane and in the cytoplasm. They exert their known biological effects via interaction with cellular components such as the plasma membrane, the cytoplasmic component, the nuclear receptor, and the nuclear matrix. Estrogens and androgens are detected in the serum of both sexes, which shows the necessity of both steroids for the expression of either sex characteristics. Sex steroids and their metabolites can demonstrate individually different biological effects, suggesting the presence of the individual receptors. The presence of cooperative effects among each steroid induces complexity in the evaluation of each steroid effect. As to the imbalance of the effects of sex steroids, the predominance of estrogens induces female dimorphism of autoimmune diseases and the protective effects on psychoneurological diseases, and that of androgens does the reverse. The continuous exposure to estrogens (and androgens) may induce benign and malignant tumors in their target organs. Various mutations mainly in sex steroid receptor genes, and other unknown abnormalities cause sex steroid resistance, e.g. male pseudohermaphroditism and uterine dysfunction. Finally, climacteric disorders are derived from estrogen-deficiency and can be managed by estrogens under the milieu of an expanded lifespan.

Androgens↗
PubMed2001

Histomorphometric approach of bone loss in men.

From a review of the published literature the authors have described the histomorphometric changes observed in human iliac bone corresponding to the age-related bone loss in 'males and in "idiopathic" male osteoporosis. Age-related bone loss of about 30% is histomorphometrically characterized in males by a reduction in iliac cancellous bone volume between ages 20 and 70-80 years, less marked than in women (-42%). The age-related thinning of trabecular packets wall width is the same between males and females, but trabecular separation is lower in aged males than in aged females, suggesting a better preservation of the trabecular microarchitecture in elderly males. Trabecular eroded surfaces increase with age in females but not in males. The rare studies comparing bone formation parameters in males and females did not show any major difference, with a trend for a decrease in mineralization apposition rate and an increase in activation frequency in both sexes. Bone histomorphometry in "idiopathic" male osteoporosis is characterized by a mean decrease in cancellous bone volume of 35% compared with age-matched controls, similar to the mean decrease observed in females (-38%). Most, but not all authors have found an increase in bone resorption parameters and a decrease in bone static and dynamic formation indices (osteoid surfaces, mineralizing surfaces, bone formation rate).

Adult↗
PubMed1993

The male climacterium.

In contrast to women, fertility in men persists until a very old age. However, testicular function of both the exo- and endocrine compartments decreases in old age, causing a series of clinical symptoms which are analogous to, although less pronounced than, the menopausal syndrome. These symptoms can be considered to represent the male climacterium or andropause. However, whereas at menopause ovarian hormonal secretion ceases almost completely, the decrease in the levels of biologically active endrogens (free testosterone) is only moderate and many elderly men have free androgen levels that would be considered normal for young men. Moreover, whereas many well-controlled studies have shown the benefit of hormonal replacement therapy, at least for symptomatic posmenopausal women, so far no well-controlled studies exist that prove a favourable risk/benefit balance of androgen substitution in elderly men. The major risk is the potentially stimulating effect of androgens in elderly men who frequently present with subclinical prostatic carcinoma. Therefore, the generalized use of androgen substitution in elderly men cannot, as yet, be recommended.

Aged↗
PubMedDate not supplied

[Tetanus in the climacterium].

OBJECTIVE: The purpose of this study was to evaluate Brazilian women in the climacterium who are affected by tetanus. METHODS: Data were collected from publications of DATASUS/Ministério da Saúde (Health Ministry) referring to hospital admissions (SIH) in hospitals of the Sistema Unico de Saúde (SUS) (Official Health System) and accorded hospitals. The numbers of vaccinations administered were obtained at the National Program of immunizations. Data regarding the population was obtained at the Brazilian Geography and Statistics Institute (IBGE). RESULTS: Between January 2001 and July 2004, while for the male gender, with the passing of years there was reduction in the total number of admissions due to tetanus, for the female gender there was an increase. Frequency of the disease, for both genders aged from 35 to 64 years in the different regions of Brazil, disclosed that the there is a higher incidence in the Northeast, followed by the Southeast and South. Data for the year 2002 showed that in the age bracket from 50 to 59 years, only 15.73% of the people were adequately protected against tetanus. CONCLUSIONS: In the adult phase, healthy life depends on public health policies, in the sense of supplying appropriate prevention against the disease. In the case of tetanus, vaccination is an effective prevention.

Adult↗
PubMed1994

Tamoxifen administration is associated with a high rate of treatment-limiting symptoms in male breast cancer patients.

BACKGROUND: Although an uncommon disease, male breast cancer (MBC) will be responsible for 300 deaths in 1993 in the United States. Because of the high rate of estrogen receptor positivity in males, adjuvant hormonal therapy with tamoxifen in the adjuvant setting has been used widely. Little is known about the side effects of this estrogen receptor blocker in males. METHODS: The authors evaluated the side effects of adjuvant tamoxifen treatment in 24 patients (19 of whom were estrogen receptor positive) treated at the authors' institution between 1990 and 1993. RESULTS: Fifteen (62.5%) patients reported at least one side effect. The most common side effect was a decrease in libido, which occurred in 7 (29.2%) patients; followed by weight gain, which occurred in 6 (25%) patients; hot flashes, which occurred in 5 (20.8%); mood alterations, which occurred in 5 (20.8%); depression, which occurred in 4 (16.6%); insomnia, which occurred in 3 (12.5%); and deep venous thrombosis, which occurred in 1 (4.2%). Five (20.8%) patients terminated treatment with tamoxifen in less than 1 year because of these side effects. Two of these patients had decreased libido, two had hot flashes, and one suffered deep venous thrombosis. CONCLUSIONS: In contrast to female breast cancer patients, who have a 4% attrition rate to adjuvant tamoxifen treatment, MBC patients have a 20.8% attrition rate related to side effects of tamoxifen treatment.

Adult↗
PubMed2001

The andropause and memory loss: is there a link between androgen decline and dementia in the aging male?

Studies demonstrate a decline in androgens with age and this results in the andropause. The objective of this paper is to review the literature on hormonal changes that occur in the aging males and determine if there are associations between decreased testosterone, dehydroepiandrosterone (DHEA) and decreased cognitive function. Trials of androgen replacement and its impact on cognitive function will also be analyzed. Method of analysis will be by a thorough search of articles on MEDLINE, the Internet and major abstract databases. Results of the author's own research in 302 men of the association of memory loss as a symptom in the andropause will be presented. In addition, the authors open trial of testosterone replacement in hypogonadic men with Alzheimer's disease will also be presented. The results of the author's trial will be compared with other investigators. High endogenous testosterone level predicted better performance on visual spatial tests in several studies, but not in all studies. Likewise, testosterone replacement in hypogonadic patients improved cognitive functions in some but not all studies. Testosterone has also been shown to improve cognitive function in eugonadal men. Several studies have shown that declines in DHEA may contribute to Alzheimer's disease and the results of double blind studies with DHEA replacement and its effect on cognition will also be presented. In summary, there is still no consensus that androgen replacement is beneficial in cognitive decline but this option may prove promising in some patients.

Aging↗
PubMed1994

Prevalence and duration of hot flushes after surgical or medical castration in men with prostatic carcinoma.

A total of 77 men with prostatic carcinoma treated with orchiectomy or a gonadotropin releasing hormone analogue before September 1987 underwent evaluation by a questionnaire regarding vasomotor symptoms. Answers were received from 84% of the patients. Of 63 patients 43 (68%) reported hot flushes during treatment, while 30 (48%) still had flushes 5 years after treatment. Of the latter 30 patients 28 (median 7.6 years after treatment) had vasomotor symptoms at the time of the study. Only 13 of 43 men with vasomotor symptoms after the start of treatment had relief 5 years later. At the time of the study 13 of 30 patients (more than 40%) still had flushes 8 years after castration. Most men reported that the flushes presently had the same frequency and duration as when they started therapy. Contrary to the general belief that the symptoms disappear with time, our study highlighted a long persistence of hot flushes after castration.

Aged↗
PubMed1988

Absence of sustained reflex vasoconstriction in women with menopausal flushes.

Reflex vasoconstriction was examined using the digital vasoconstrictor response to ice application in 10 flushing and six non-flushing menopausal women, 22 premenopausal women and eight men. Nine of the 10 women experiencing flushes lacked the vasoconstrictor response which was present in all the other groups examined, suggesting an abnormality of autonomic nervous control. Our observation is of particular interest since it has previously not been possible to apply any biochemical or biophysical tests which differentiate flushing from non-flushing subjects except during an actual flush.

Adult↗
PubMed2000

Andropause, testosterone therapy, and quality of life in aging men.

Testosterone therapy can improve quality of life in aging men because aging is accompanied by declining testosterone levels that may contribute to decreases in muscle mass, bone density, libido, stamina, and cognition. Hypogonadal men can be identified by a test for bioavailable testosterone or by a free testosterone assay that uses dialysis or ultracentrifugation methods.

Aging↗