Textbook of Men’s Health and Aging 2nd Edition pdf

Textbook of Men’s

Health and Aging

2nd Edition

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Textbook of Men’s

Health and Aging

2nd Edition

Editors in Chief

Bruno Lunenfeld MD FRCOG FACOG [Hon]

Professor Emeritus, Reproductive Endocrinology,

Bar-Ilan University, Ramat Gan

Israel

Louis JG Gooren MD

Professor, Vrjie Universiteit Medical Center,

Amsterdam, The Netherlands

Alvaro Morales MD

Queen’s University General Hospital,

Kingston, Ontario, Canada

John E Morley MB MCh

St Louis University,

St Louis, MO, USA

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© 2007 Informa UK Ltd

First published in the United Kingdom in 2007 by Informa Healthcare, Telephone House, 69-77 Paul Street, London EC2A 4LQ.

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would be glad to acknowledge in subsequent reprints or editions any omissions brought to our attention.

Although every effort has been made to ensure that drug doses and other information are presented accurately in this publication,

the ultimate responsibility rests with the prescribing physician. Neither the publishers nor the authors can be held responsible for

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ISBN-10: 0 419 425808

ISBN-13: 978 0 415 42580 3

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Foreword

This a long road knows no turning (Sophokles: Ajax)

In the “sleepwalkers” (1964) Arthur Koestler

remarks that “I mistrust the word progress and much

prefer the word evolution simply because progress,

by definition, can never go wrong, whereas evolu￾tion constantly does and so does the evolution of

the ideas. Indeed, it is fascinating to observe

throughout history the evolution of quite a few “rul￾ing” ideas , moving from gradual acceptance, to

popularization, vulgarization, overextension, col￾lapse and disappearance. At the height of their

importance, some of them are so generally accepted,

that they become the spirit of the time (the famous

“Zeitgeist” in German) with all of its societal conse￾quences, masterfully characterized by Virginia

Woolf (1929) saying that “what is amusing now had

to be taken in desperate earnest once”. Other ideas

may show a markedly different evolution; as Jean

Monnet (1978) emphasized in his Mémoires, “When

an idea corresponds to the necessity of an epoch , it

ceases to belong to those who invented it and it

becomes stronger than those who are in charge of

it”. In fact, such an idea may become stronger than

political power by developing into the common

property of humankind ; it may deeply influence the

spiritual content of an entire era and may resist the

historical forces of destruction for a long time. In a

few, rare , cases a new idea becomes exceptionally

strong, when – in addition – it is generated as a

response to powerful historical challenges by some

new realities. The ageing of populations presents

such a challenge. It is a fundamentally new and

unique problem in our history, with no previous

analogies. Hence, people and their governments

have not had yet enough time (and/or courage?) to

consider the necessary - and in part fundamental –

socioeconomical and political adjustments needed

to meet one of the greatest challenges of the 21st

century, which will profoundly affect many aspects

of our life, social institutions and perhaps even eth￾ical values. The Population division of the United

Nations Secretariat estimates that last year (2006)

some 11% of the global population (688 million

persons) were aged 60 years or more and 13% of

these persons were aged 80 years and over. The sex

ratio of those aged 60 and over was 82 men for 100

women and among those aged 80 years and more it

was 55 men for 100 women. Life expectancy at the

age of 60 was 17 years for men and 21 years for

women. The Population division projects that by

the year 2050 , 22% of the world population (or

almost 2 billion people) will be aged 60 years and

over and that 20% of these 2 billion persons will be

aged 80 years or more. The United Nations also

point out that, by the year 2050 – for the first time

in our history – the population of persons older than

60 years will be larger than the population of chil￾dren (0 to 14 years of age). Humankind is growing

rapidly and it is ageing very rapidly… Fortunately,

scientific knowledge is growing even more rapidly .

In 1830, Alfred Tennyson still could say with some

justification that “Science moves, but slowly slowly,

creeping on from point to point ”. However, by the

mid-fiftees of the 20th century it was recognized,

that science progresses in proportion to the mass of

knowledge that is left to it by preceding generations,

that is under the most ordinary circumstances in

geometrical proportion (F.Engels, 1963). The same

year Derek John de Solla Price has put this progress

in a proper perspective: “Using any reasonable defi￾nition of a scientist, we can say that between 80 and

90 per cent of all scientists that have ever lived are

alive now. Now depending on what one measures

and how, the crude size of science in manpower or

in publications tends to double within a period of

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Foreword

vi

10 to 15 years”. This was 44 years ago and nowadays

it is often said that today the amount of new infor￾mation tends to double every 6 to 7 years…. And

when the amount of new information increases so

rapidly, the perimeter between the known and

unknown also increases and opens new avenues

for fruitful investigation. If I am allowed to quote

another forword written more than 400 years ago, in

the Preface to De La Sagesse, Pierre Charron

remarks that “La vraye science et le vray étude de

l´homme c´est l´homme” (The true science and study

of mankind is

man). This will particularly be true in the world of

tomorrow, where the octagenarian populations will

grow most rapidly of all groups and lot of new infor￾mation will be required on their pathophysiology

and optimal medical care.It is said, that Leonardo

da Vinci was the last scientist in history, who still

could grasp the entire body of knowledge of his

epoch. I doubt very much that there exists any med￾ical scientist today, who could claim to grasp all

medical knowledge, or eventhat of any major disci￾pline, the Study of the Ageing Male being no

exception. It is sufficient to look at a few of the

almost 60 excellent articles of the present textbook

to be convinced. Science is organized knowledge, said

Herbert Spencer; therefore, a textbook will always

represent an important contribution to the body of

contemporary knowledge, particularly, when it

contains so many carefully selected articles, as the

present textbook. In fact, when the perimeter

between the known and unknown rapidly increases,

it inevitably results in increasing specialisation and

in the establishment of new disciplines. The estab￾lishment of a new discipline for the Study of the

Ageing Male slightly more than a decade ago, was

considered then by some medical scientists as a

courageous innovation with a somewhat uncertain

future. Few, if any of them would doubt today that

this discipline has come to stay and for a long time,

since more and more evidence is forthcoming to

indicate that many aspects of ageing are gender spe￾cific, like the localisation of certain receptors in dif￾ferent tissues or the functions of the blood-brain

barrier. Therefore, an in-depth study of the various

aspects of gender specificity is likely to lead to

improved diagnostic and therapeutic methods for

ageing populations. Therefore, as Shakespeare says

“What is past is prologue”. Last, but not least, I feel

that the scientific community ought to be grateful

to theeditors and contributors of this Textbook.

Their effort should remind us that the acquisition,

critical evaluation, systematisation and dissemina￾tion of positive knowledge are the only human

activities which are truly cumulative and progres￾sive (George Sarton, 1930, paraphrased).

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Preface & Acknowledgments

Text to come

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Contents

Introduction 1

History of research on the aging male – selected aspects 1

Micheal Oettel, Sergio Musitelli & Dirk Schultheiss

Section I: Biology of aging 11

1. The biology of gender differences in animal models of aging 13

HJ Armbrecht

2. The biologic basis for longevity differences between men & women 23

Rafi T Kevorkian & Oscar A Cepeda

3. The biology of the aging brain 31

Xi Chen & Shirley Shidu Yan

4. The blood-brain barrier: age & gender differences 39

William A Banks

Section II: Diagnostics & Primary Assessment 47

5. Aging men – The challenge ahead 49

Bruno Lunenfeld

6. Screening of the aging male 63

Louis JG Gooren, Alvaro Morales & Bruno Lunenfeld

7. Laboratory tests in the endocrine evaluation of aging males 97

Michael John Wheeler

Section III: The Genitourinary System 111

8. Genitourinary System: an introduction 113

Claude C. Schulman

9. Benign prostatic hyperplasia 115

Simon RJ Bott & Roger S Kirby

10. Prostate cancer 131

Michaël Peyromaure, Vincent Ravery & Laurent Boccon-Gibod

11. Erectile dysfunction in the aging male 147

Andrea Gallina, Alberto Briganti, Andrea Salonia, Federico Dehò,

Giuseppe Zanni, Pierre I Karahiewiz & Francesco Montorsi

12. Infertility in the aging male 161

Wolfgang Weidner, Thorsten Diemer & Martin Bergmann

13. Urinary incontinence 167

Adrian Wagg

14. Testicular cancer 183

Axel Heidenreich

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Section IV: Sexual Dysfunction 205

15. Treatment of erectile dysfunction in the elderly 207

Kok Bin Lim & Gerald B Brock

16. Assessment of the aging man with sexual dysfunction 229

Sidney Glina

Section V: Endocrine System 239

17. Endocrinology of the aging male: an overview 241

John E Morley

18. Androgen deficiency and its management in elderly men 245

Louis JG Gooren & Bruno Lunenfeld

19. Growth hormone and aging in men 265

Marc R Blackman

20. The Thyroid 273

Mary H Samuels & Jerome M Hershman

Section VI: Aging and Body Composition 281

21. Aging testosterone, and body composition 283

Alex Vermeulen

22. Growth hormone & body composition in the aging male 289

Fred Sattler

23. Androgens & lean body mass in the aging male 307

Melinda Sheffield-Moore, Shanon Casperson & Randall J Urban

24. Visceral obesity, androgens and the risks of cardiovascular disease 313

Louis JG Gooren

Section VII: Nutrition, Digestion and Metabolism 327

25. Nutrition in older men 329

David R Thomas

26. Obesity in middle-aged men 345

Richard YT Chen & Gary A Wittert

27. Diabetes in the elderly male: nutritional aspects 355

John E Morley

28. Lipids through the ages 363

Margaret-Mary G Wilson

29. Insulin resistance syndrome in older people 373

Angela Marie Abbatecola & Giuseppe Paolisso

30. Free radicals and vitamins 391

Seema Joshi

31. Resistance exercise 405

Charles P Lambert

32. Constipation & diarrhoea 421

Syed H Tariq

33. Macrovascular complications in the elderly diabetic 431

Nikiforos Ballian, Mahmoud Malas, and Dariush Elahi

34. Upper gastrointestinal complaints 443

Christopher K Rayner & Michael Horowitz

Contents

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Section VIII: Cardiovascular and Respiratory System 463

35. Atherosclerotic risk assessment of androgen therapy in aging men 465

David Crook

36. Male aging: changes in metabolic, inflammatory, and endothelial

indices of cardiovascular risk 473

Ian F Godsland

37. Androgens: Studies in animal models of atherosclerosis 487

Peter Alexandersen

38. Androgens and blood pressure in men 501

Guy Lloyd

39. Androgens and arterial disease 511

Carolyn M Webb & Peter Collins

40. Androgenic influences on ventilation and ventilatory responses to

oxygen and carbon dioxide during wakefulness and sleep 517

Christopher P Cardozo

41. The role of androgens in respiratory function 521

Ann M Spungen

Section IX: Central Nervous System and Psyche 529

42. Changes in libido/sex life 531

Syed H Tariq

43. Depression 539

Margaret-Mary G Wilson

44. Testosterone, depression and cognitive function 551

John E Morley

45. Modern antidepressants 561

Margaret-Mary G Wilson

46. Sleep disorders 575

Hosam K Kamel

47. Cognitive changes in aging 683

Syed H Tariq & John E Morley

Section X: Skeletal System 609

48. Bone loss and osteoporotic fracture occurrence in aging men 611

Steven Boonen & Dirk Vanderschueren

Section XI: Sensory Organs 619

49. Aging and the eye 621

Ali R Djalilian & Hamid R Djalilian

50. Aging and inner ear dysfunction 631

Emiro Caicedo, Diego Preciado, George Harris & Frank Ondrey

51. Smell and taste 645

Weiru Shao & Frank Ondrey

Section XII: Skin and Hair 659

52. Healthy skin aging 661

Walter Krause

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Contents

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53. Skin disease caused by changes in the immune system and infection 677

Isaak Effendy and Karen Kuschela

54. Skin changes caused by venous diseases 691

Eberhard Rabe & F Pannier

55. Aging of Hair 697

Ralph Trüeb & Rolf Hoffmann

Epilogue 709

56. Hormone treatment and preventative strategies in aging men:

whom to treat, when to treat and how to treat 711

Louis JG Gooren, Alvaro Morales & Bruno Lunenfeld

Index 731

Contents

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Angela Marie Abbatecola

Department of Geriatric Medicine

and Metabolic Diseases

Il University of Naples

Italy

Peter Alexandersen, MD

Center for Clinical & Basic Research

Vejle, Denmark

HJ Armbrecht PhD

Professor of Biochemistry &

Molecular Biology

Geriatric Research, Education &

Clinical Center

St. Louis VA Medical Center

St. Louis, MO, USA &

St. Louis University

School of Medicine, MO

USA

Nikiforos Ballian

Johns Hopkins University

School of Medicine

USA

William A Banks, MD

GRECC, VA Medical Center

St. Louis & Division of Geriatric,

Department of Internal Medicine

St. Louis University School of Medicine, MO

USA

Martin Bergmann

Institut fur Veterinär-Anatomie

Histologie und Embryologie

der Justus-Liebig-Universität Giessen

Germany

Marc R Blackman, MD

National Center for Complementary &

Alternative Medicine

National Institutes of Health

Bethesda, MD

USA

Laurent Boccon-Gibod, MD PhD

Professor

CHU BICHAT

University of Paris VII, Paris

France

Steven Boonen, MD PhD

Leuven University Center for Metabolic Bone Diseases

Katholieke Universiteit Leuven

Belgium

Simon RJ Bott, FRCS

Trustees of the London Clinic Ltd

London

UK

Alberto Briganti

Department of Urology

Vita-Salute University

Milan

Italy

Gerald B Brock MD FRCSC

St. Joseph's Health Centre

London

Canada

Emiro Caicedo, MD

University of Minnesota

Minneapolis, MN

USA

Contributors

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Christopher P Cardozo MD

VA Medical Center

Bronx, NY, USA and

Associate Professor of Medicine

Mount Sinai School of Medicine

New York, NY

USA

Shanon Casperson, DTR

Oscar A Cepeda, MD

Fellow, Division of Geriatric Medicine

Department of Internal Medicine

St. Louis University School

of Medicine & GRECC VA Medical Center

St. Louis, MO

USA

Richard YT Chen

Associate Consultant (Endocrinology)

Department of Medicine

Changi General Hospital

Singapore

Xi Chen, MD PhD

Department of Neurology

St. Louis University School of Medicine &

St Louis VA Medical Center, MO

USA

Peter Collins MD FRCP FESC

National Heart & Lung Institute

London

UK

David Crook, PhD

St. Bartholomew’s & Royal London School of Medicine

London

UK

Federico Dehò

Department of Urology

Vita-Salute University

Milan

Italy

Thorsten Diemer

Poliklnik für Urologie und Kinderurologie

Zentrum für Chirurgie, Anästhesiologie

und Urologie, Universitätsklinikum

Giessen und Marburg GmbH

Standort Giessen

Justus-Liebig-Universität Giessen

Germany

Ali R Djalilian, MD

National Eye & Health Institute

Bethesda, MD

USA

Hamid R Djalilian, MD

UCI Medical Center

University of California

Irvine, CA, USA

Isaak Effendy MD

Department of Dermatology

Municipal Hospital of Bielefeld

Germany

Dariush Elahi, MD

Johns Hopkins University

School of Medicine

USA

Andrea Gallina

Department of Urology

Vita-Salute University

Milan

Italy

Spas V Getov

Academic F2 SHO in Stroke Medicine

Brighton and Sussex University Hospitals

UK

Sidney Glina, MD PhD

Head of Department of Urology

Hospital Ipiranga, and Director of Instituto H Ellis

São Paulo

Brazil

Contributors

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