Raising Hope for Fading Manhood

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Information about Raising Hope for Fading Manhood

Published on August 31, 2008

Author: drho

Source: slideshare.net

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Dr Ho Siew Hong lectured to participants of 'Clarifiying Misconceptions' Public Forum

Raising Hope for Fading Manhood Dr Ho Siew Hong Consultant Urologist S H Ho Urology and Laparoscopy Centre Gleneagles Hospital

Fading manhood – Myth or Fact? Aging Females --> Menopause Men-no-pause Gradual process

Aging

Females --> Menopause

Men-no-pause

Gradual process

Changes as a man ages Muscle and bone structure Fat distribution Mental – short term memory, concentration, restful sleep Medical problems – hypertension, diabetes, heart diseases, prostate problems Sexual function – erectile dysfunction

Muscle and bone structure

Fat distribution

Mental – short term memory, concentration, restful sleep

Medical problems – hypertension, diabetes, heart diseases, prostate problems

Sexual function – erectile dysfunction

What is Erectile Dysfunction (ED) ? Consistent or recurrent inability of a man to attain and/or maintain a penile erection sufficient for sexual activity Independent of sexual desire and the ability to have an orgasm and ejaculate National Institute of Health, USA

Consistent or recurrent inability of a man to attain and/or maintain a penile erection sufficient for sexual activity

Independent of sexual desire and the ability to have an orgasm and ejaculate

Hope for the fading manhood? YES

YES

Do I have ED ? Doctor - Family Physician / Specialist Medical and psychological history from patient and partner Sexual history IIEF Questionaire Focused physical examination

Doctor - Family Physician / Specialist

Medical and psychological history from patient and partner

Sexual history

IIEF Questionaire

Focused physical examination

Current treatment for ED Tablets – PDE 5 inhibitors Testosterone replacement therapy Intracavernosal injection Vacuum device Surgery

Tablets – PDE 5 inhibitors

Testosterone replacement therapy

Intracavernosal injection

Vacuum device

Surgery

Oral erectogenic medications Phosphordiesterase inhibitors (PDE5I) Approved for treatment of erectile dysfunction by FDA in 1998 Arrived in shores of Singapore in 21 st century 1 st line of treatment for organic ED Levitra, Viagra, Cialis

Phosphordiesterase inhibitors (PDE5I)

Approved for treatment of erectile dysfunction by FDA in 1998

Arrived in shores of Singapore in 21 st century

1 st line of treatment for organic ED

Levitra, Viagra, Cialis

Are they effective? Effective in 80% - 84 % Satisfactory erection for penetration In the presence of sexual stimulation Correct dosing Correct method of administration Less effective in patients with serious diabetes mellitus, hypertension and other long standing medical conditions

Effective in 80% - 84 %

Satisfactory erection for penetration

In the presence of sexual stimulation

Correct dosing

Correct method of administration

Less effective in patients with serious diabetes mellitus, hypertension and other long standing medical conditions

What are the side-effects? Headache 15% Flushing 3 – 10% N congestion 5 – 10% Indigestion 3 - 10% Visual disturbance (blue vision) 5%

Headache 15%

Flushing 3 – 10%

N congestion 5 – 10%

Indigestion 3 - 10%

Visual disturbance (blue vision) 5%

Contra-indications All patients taking medications with nitrates Caution: heart problems (ischaemic heart, valve) Cause sudden and severely low blood pressure

All patients taking medications with nitrates

Caution: heart problems (ischaemic heart, valve)

Cause sudden and severely low blood pressure

How to use them effectively and safely? Only use with prescription from a doctor (not a friend !) Regular check-ups with doctor Correct dose, timing and expectation Do not over dose or mix and match (more does not mean better !) Talk to your partner

Only use with prescription from a doctor (not a friend !)

Regular check-ups with doctor

Correct dose, timing and expectation

Do not over dose or mix and match (more does not mean better !)

Talk to your partner

What if PDE5I is not effective?

In non-responders to PDE-5 inhibitors, look for co-morbidities Failure rate of 18 – 37% is reported Depending on co-morbidities thereof: Hypogonadism 50% Diabetes mellitus 35% LUTS / BPS 22% Hypertension 23% Yassin et al. IJIR Vol. 14, Suppl. 3, 9/2002

Failure rate of 18 – 37% is reported

Depending on co-morbidities thereof:

Hypogonadism 50%

Diabetes mellitus 35%

LUTS / BPS 22%

Hypertension 23%

Testosterone level and aging

Function of Testosterone Lower voice Muscle mass Body and facial hair Penile length and width increase Mental – aggressive, active, interest in opposite sex, libido, memory, concentration Acne Prostate enlarges

Late Onset Hypogonadism ADAM, PADAM, Andropause ‘ clinical and biochemical syndrome associated with advancing age and characterized by typical symptoms and a deficiency in serum testosterone levels. It may result insignificant detriment in the quality of life and adversely affect the function of multiple organ systems ’ ISA, ISSAM, and EAU recommendations SUA recommendations

ADAM, PADAM, Andropause

‘ clinical and biochemical syndrome associated with advancing age and characterized by typical symptoms and a deficiency in serum testosterone levels. It may result insignificant detriment in the quality of life and adversely affect the function of multiple organ systems ’

ISA, ISSAM, and EAU recommendations

SUA recommendations

Clinical manifestation of LOH The easily recognized features of diminished sexual desire (libido) and erectile quality and frequency, particularly nocturnal erections Changes in mood with concomitant decreases in intellectual activity, cognitive functions, spatial orientation ability, fatigue, depressed mood and irritability Sleep disturbances Decrease in lean body mass with associated diminution in muscle volume and strength Increase in visceral fat Decrease in body hair and skin alterations Decreased bone mineral density resulting in osteopenia, osteoporosis and increased risk of bone fractures

The easily recognized features of diminished sexual desire (libido) and erectile quality and frequency, particularly nocturnal erections

Changes in mood with concomitant decreases in intellectual activity, cognitive functions, spatial orientation ability, fatigue, depressed mood and irritability

Sleep disturbances

Decrease in lean body mass with associated diminution in muscle volume and strength

Increase in visceral fat

Decrease in body hair and skin alterations

Decreased bone mineral density resulting in osteopenia, osteoporosis and increased risk of bone fractures

Diagnosing Andropause Symptoms Blood tests: Testosterone Tests usually done in the morning

Symptoms

Blood tests: Testosterone

Tests usually done in the morning

Treatment for Andropause

Testosterone replacement therapy Tablets – Andriol Injections - 3 weekly - 3 monthly (Nebido) Skin patch, gel

Tablets – Andriol

Injections - 3 weekly - 3 monthly (Nebido)

Skin patch, gel

Effect of Castration and Androgen Substitution on Trabecular Smooth Muscle and Connective Tissue Content in the Corpus cavernosum Traish A et al. Endocrinol 140(4): 1861-1868 (1999) Control Castrated + Vehicle Castrated + Testosterone

Overall Response Rate to Testosterone Treatment for Erectile Dysfunction in Hypogonadal Men: Results of a Meta-Analysis Jain P et al. J Urol 164: 371-375 (2000) 203 (57.02 %) 356 Total 14 (100 %) 14 Conway 1988 12 (100 %) 12 Skakkebaek 1981 22 (75.86 %) 29 Arver 1996 10 (43.48 %) 23 Morales 1997 3 (50 %) 6 Kwan 1983 5 (100 %) 5 Ahmed 1988 3 (75 %) 4 Carey 1988 6 (100 %) 6 Davidson 1979 6 (42.86 %) 14 Carani 1990 5 (38.46 %) 13 Benkert 1979 10 (100 %) 10 Nankin 1986 4 (100 %) 4 McClure 1991 10 (83.33 %) 12 Jacobs 1982 21 (95.45 %) 22 Spark 1980 12 (66.67 %) 18 Ou 1991 60 (36.59 %) 164 Baskin 1989

Testosterone treatment improves bone mineral density and may reduce the incidence of fractures. Testosterone treatment improves body composition, muscle function, and erythropoiesis. Testosterone treatment improves libido and nocturnal erections. Pilot studies and ongoing clinical studies support the role of testosterone in the management of all components of the metabolic syndrome and its associated diseases. Summary and Conclusions

Testosterone treatment improves bone mineral density and may reduce the incidence of fractures.

Testosterone treatment improves body composition, muscle function, and erythropoiesis.

Testosterone treatment improves libido and nocturnal erections.

Pilot studies and ongoing clinical studies support the role of testosterone in the management of all components of the metabolic syndrome and its associated diseases.

Monitoring and Safety Monitoring Baseline: DRE, PSA, fasting lipids, Hb and Hct Improvement in symptoms DRE, PSA, Hb and Hct every 3 months for 1 st year, then yearly, fasting lipids yearly Safety no clear relationship between HRT and prostate cancer anecdotal reports linking HRT to prostate cancer Not recommended in patients with or suspected of prostate cancer

Monitoring

Baseline: DRE, PSA, fasting lipids, Hb and Hct

Improvement in symptoms

DRE, PSA, Hb and Hct every 3 months for 1 st year,

then yearly, fasting lipids yearly

Safety

no clear relationship between HRT and prostate cancer

anecdotal reports linking HRT to prostate cancer

Not recommended in patients with or suspected of prostate cancer

Take home message There is hope for the fading manhood PDE 5 inhibitor tablets are effective in 80% Recognize condition of low male hormone (testosterone) Testosterone replacement in selected patients is effective Treatment must be discussed, administered and monitored by health care professionals

There is hope for the fading manhood

PDE 5 inhibitor tablets are effective in 80%

Recognize condition of low male hormone (testosterone)

Testosterone replacement in selected patients is effective

Treatment must be discussed, administered and monitored by health care professionals

Thank you

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