Why does the ISMH run a campaign about hypogonadism?

There are three main topics in the field of men´s health: prostate health, erectile dysfunction and hypogonadism/TDS. The ISMH choose hypogonadism/TDS for the campaign as it is often correlated with other severe disease as diabetes, obesity, atherosclerosis or cardiovascular disease. Furthermore men with hypogonadism do have a lower life expectancy than men with normal testosterone level (Khaw K-T et al., Circulation 2007;116: 2694-2701, Shores MM, Matsumoto AM, Sloan KL, Kivlahan DR, Arch Intern Med. 2006;166:1660-1665).

 What is the purpose of the campaign?

Many men have testosterone deficiency without knowing it. They are suffering from non-specific symptoms and most have no idea that apathy, irritability, lethargy and loss of libido may be due to hypogonadism caused by low levels of testosterone. Almost nobody knows that testosterone production is decreasing with increasing visceral fat while, at the same time, testosterone is needed to metabolize visceral fat. It is a vicious circle. More informed men can make better decision in regard to their health when they are aware of the consequences.

The aim of the campaign is to help men and their partners recognize that certain changes they may be experiencing might not be due just to aging, make them ask a doctor about it and help to prevent long-term effects like the metabolic syndrome.

Men are not likely to talk or read about their health problems and go to the doctor. This is why the campaign is being displayed in daily newspapers, finance and sport magazines. With the football a key visual was chosen that grabs the attention of many men in a more humorous way trying to channel their interest towards the important taboo afflicted health topic of hypogonadism.

What are GPs interested in/aware of when it comes to TDS?

Hypogonadism/TDS awareness amongst health care professional is usually low, treatment rates in Europe are about ¼ compared to the US. However, interest and knowledge of GPs are increasing along with the growing scientific understanding that hypogonadism is no life style issue and not part of the normal aging process. Hypogonadism caused by low levels of testosterone is often associated with serious health issues in men (Muller M et al, European Journal of Endocrinology 2003; 149 583–589; Mulligan T et al, Int J Clin Pract 2006; 60, 7, 762–769). This is the reason why the ISMH is requesting more international studies on testosterone and related medical conditions. The call for more research was one of the results of the ISMH consensus conference 2010 in New York. The ISMH runs a number of educational initiatives and more efforts are planned in the next future.

Who came up with the idea to start this campaign?

The concept was formed during the ISMH consensus conference on hypogonadism and testosterone replacement therapy (TRT) in New York in 2010 (Traish A et al, Am J Med 2011; 124: 578-587; Wang C et al, Diab Care 2011; 34: 1669-1675). This scientific meeting of 25 international experts was also attended by many pharmaceutical companies including Bayer. The current campaign about symptoms of hypogonadism caused by low levels of testosterone in Sweden is a logical result of this conference and the publications resulting from this meeting. It is part of the ISMH’s mission to improve the health of men and empower them to pursue healthier lives. Bayer is named as the sponsor for this campaign, but the ISMH is responsible for content and the wording of the campaign. Additionally, the campaign is not related to any product but suggests to men with symptoms to consult their doctors. Other industry partners would be very welcome as these would help to increase the impact of this awareness campaign on the TDS/hypogonadism.

You can contact us through our website (http://www.ismh.org/en/contact/) or our bureau in Vienna:

Lazarettgasse 9/5
1090 Vienna, Austria
Tel +43/ (0)1 / 904 78 12
Fax +43/ (0)1 / 409 60 11
E-Mail office@ismh.org

In this trial, sex hormones exhibited direct relationships with all-cause mortality, as the relationship between low free T, elevated sex hormone binding globulin (SHBG), and elevated LH were statistically significant in association with cardiovascular mortality.  While there was a noticeable relationship between total T and increased mortality, this relationship did not reach statistical significance.  Overall, men with both low free T and high LH were at greatest risk of cardiovascular mortality.  Higher T levels were associated with lung cancer, and elevated SHBG levels were associated with non-CVD mortality.

The study concluded that low serum free T may predict mortality from CVD, yet a true cause-and-effect relationship cannot be exclusively determined.  The authors postulate that prevention and early treatment of androgen deficiency syndrome may improve CV outcomes, but not necessarily mortality from other outcomes.

This study can be contrasted with a previous trial published in 2010 with men who received T supplementation (Basaria S, et al.  NEJM 2010).  This trial examined 209 men at mean 74 years of age, all of whom had a high prevalence of hypertension, diabetes mellitus, hyperlipidemia, and obesity.  The conclusions stated that use of T gel in these men was associated with increased risk of adverse CV events, questioning the safety of T supplementation.  Additional and more rigorous trials are needed to better elucidate more clear relationships between T and cardiovascular mortality risks.

Hyde Z, Norman PE, Flicker L, et al.  Low free testosterone predicts mortality from cardiovascular disease but not other causes: The Health in Men Study.  J Clin Endocrinol Metab published ahead of print as doi:10.1210/jc.2011-1617.

 This statement has received significant media attention in the United States and in Europe, and is felt to be very controversial.  The American Urological Association (AUA) responded immediately to the USPSTF’s statement, citing “the task force’s recommendations will ultimately do more harm than good to the many men at risk for prostate cancer, both here in the US and around the world.  Until there is a better widespread test for this potentially devastating disease, the USPSTF — by disparaging the test — is doing a great disservice to the men worldwide who may benefit from the PSA test” (AUA Daily Scope, October 13, 2011)./

Following the initial trial, observation continued, with each group having greater than 13,000 person-years of follow-up.  There were 521 additional cases of prostate cancer detected since the original study was published.  The hazard ratio in the group of men given vitamin E who developed prostate cancer was 1.17; that for the selenium group was 1.09; that for the group who received vitamin E plus selenium was 1.05.  The authors concluded absolute increased risks of prostate cancer per 1000 person-years of 1.6 for the vitamin E group; 0.8 for the selenium group; and 0.4 for the group who received both vitamin E and selenium.

Detection and prevention of prostate cancer remains an important public health goal on the worldwide level.  The authors noted that these results differ from previous studies on the relationship between vitamin E supplementation and prostate cancer risk.  The ATBC (Alpha-Tocopherol, Beta Carotene) trial reported a 35% risk reduction in men who took 50mg/day of vitamin E over an average period of 6.1 years.  The reported 17% increased risk of prostate cancer in the SELECT trial follow-up suggests not only the potential for harm through vitamin E supplementation, but as the authors also claim, there is a great need for consumers to be surveillant of the potential health benefit claims of unregulated over-the-counter products that may claim to be beneficial to overall health and cancer prevention.

Klein EA, Thompson IM, Tangen CM, et al.  Vitamin E and the risk of prostate cancer.  JAMA 2011;306(14):1549-56.

Professor Siegfried Meryn, General Secretary of the International Society of Men’s Health, explains:

“Male attitudes towards urinary symptoms have been neglected in medical research and this is one of the very few surveys that asks ‘how do men feel?’ and ‘why don’t men seek help?’ This survey will provide a unique insight about men and their health and it is vital that we, as healthcare  professionals, understand the attitudes and behaviours of the men we are treating.”

The BPH survey: a male perspective was developed by an expert steering group of urologists and GPs, and explores:

• What discourages men from seeking medical attention
• What prompts men to seek help
• Who men consult about their bothersome urinary symptoms

It is hoped that the insights will help healthcare professionals have more meaningful conversations with men about their prostate problems so that their condition can be rapidly diagnosed and managed. Findings from the survey should also help men to understand that bothersome urinary symptoms are not an inevitable part of ageing.

First findings from the survey will be released online during the Men’s Health World Congress 2011 in Vienna, Austria.

GlaxoSmithKline (GSK) is committed to supporting research to help educate and increase understanding of Benign Prostatic Hyperplasia (BPH), a common prostate disorder. As part of this commitment GSK has developed and funded this project – “The BPH survey: a male perspective” through the creation of a steering group of healthcare professionals – urologists and GPs – to advise on the content of the survey, as well as the implementation of the project across the largest European markets (UK, France, Italy, Germany and Spain).  GSK has supported and paid the International Society of Men´s Health (ISMH) for the opportunity to launch the results of this project in the press contact section of their website during their annual Men´s Health World Congress, taking place in Vienna in 2011. All rights relating to the project and the data published are property of GSK.

References

1. Garraway WM, Collins GN, Lee RJ. High prevalence of benign prostatic hypertrophy in the community. Lancet. 1991; 338: 469-71.

2. Banks I, Mayor S, Meryn S. Talking prostates. Journal of Men’s Health. 2010; 7: 221-226.

Date of preparation: September 2011 , Job bag code: URCE/BPH/0022a/11

Hypogonadotropic hypogonadism occurs in up to 33% of men with type 2 diabetes. The Massachusetts Male Aging Study found that low levels of testosterone and sex hormone binding globulin (SHBG) are independent risk factors for the development of type 2 diabetes. In addition, this study demonstrated that low serum testosterone predicts the development of metabolic syndrome.

Declining serum testosterone levels throughout a man’s life are associated with an increase in all-cause mortality and an increase in atherosclerosis, visceral obesity, insulin resistance, dyslipidemia, and hypertension, the key components of the metabolic syndrome. Prospective clinical trials in men with prostate cancer who have undergone androgen deprivation therapy have found increased cardiovascular risk by increasing body weight, reducing insulin sensitivity, and/or resulting in dyslipidemia.

Reference: Ullah MI, Washington T, Kazi M, et al. Testosterone deficiency as a risk factor for cardiovascular disease. Horm Met Res 2001;43:153-164.

More needs to be done to ensure sustainable healthcare costs, but there are flaws with IPAB that patient advocates believe will ultimately limit seniors’ access to quality healthcare.  The way that IPAB is currently designed will give the Board the ability to dramatically cut payments to healthcare providers and physicians who provide services to Medicare beneficiaries. Great concern has been expressed that doing so may result in fewer providers being willing to accept Medicare patients, ultimately, limiting seniors’ access to quality providers.

Advocates are concerned by the lack of oversight of IPAB. The Board has the power to change laws previously enacted by Congress. When IPAB puts forth proposals, the Secretary of the Department of Health and Human Services is required to implement the board’s recommendations unless Congress passes a law with the same cost savings. If Congress fails to adopt a substitute proposal, IPAB’s proposal must be implemented, meaning that IPAB’s proposal does not need Congressional approval to go into effect.

Furthermore, the Secretary’s implementation of IPAB’s recommendations is exempt from judicial and administrative review. Patient advocates are also troubled that there is no patient representation on the Board and that IPAB is not required to hold public meetings where the voices of patients, caregivers and families can be heard. Important health care decisions that can dramatically impact patients will be made by an unelected Board without accountability to the public.  Efforts are underway to explore repeal options within the United States Congress.

Source: http://www.womenagainstprostatecancer.org/2011/07/ipab-limiting-access-for-seniors/

Over 18 years, 1001 men with PD were evaluated retrospectively with regard to penile deformity, erectile function, and risk factors for cardiovascular disease.

The authors concluded that PD was predominantly determined in men during their fifth decade of life, proving that age is a positive correlating factor for development of ED.  The most common comorbidities were diabetes mellitus (26%), hyperlipidemia (24%), hypertension (18%), and ischemic heart disease (8.5%).  Systemic vascular risk factors were more commonly observed in patients with both PD and erectile dysfunction.  Lateral side of deformity was also found to be a positive correlate as well.  As a presenting symptom of PD, previous studies have reported ED in 4% to 80% of men.  The authors admit that this study lacked definitive demographic data including controls of smoking, testosterone levels, obesity and marital status.  Future research will investigate the relationship between these cofactors and PD severity.

Kadioglu A, Sanli O, Akman T, et al.  Factors affecting the degree of penile deformity in Peyronie Disease: an analysis of 1001 patients.  J Androl 2011;32:502-508.

The Forum were responding to The State of Men’s Health In Europe Report, which has been launched in the European Parliament in June 2011. The Report shows that every year twice as many men of working age (16-64) die as women with some 630,000 male and 300,000 female deaths across the EU27 countries in this age group. The Forum are calling for this group of men to be explicitly targeted.

EMHF President Ian Banks explains: ‘We’ve seen great improvements in life expectancy because older people – if they make it to retirement age – are living longer. The great black hole is men of working age where we’ve seen very little improvement in the death rates in recent years. These men have been neglected for too long. We need a wide-ranging and fundamental change in policy. This is the group we need to be targetting.’

The Report proves that lifestyle changes can make a real difference if only men can be enabled to make them.  But it also places a responsibility on policy-makers and politicians to consider the health implications of other policies such as on the economy, education, employment and housing.

Men are dying prematurely but the rates at which they do this vary enormously from country to country and even within countries according to region or social group. This is evidenced by the massive differences in male life-expectancy: just 66 years in Latvia compared to 80 in Iceland, for example – a 21% longer life.

The Report says that the data proves men’s health disadvantage is an issue of inequity and not biological inevitability.

Dr Banks says, ‘The challenge for all of us working in healthcare is to find male-friendly policies that can change this in terms of information-giving, facilitating healthier choices, screening and access to services.  But it’s also about the bigger society, the wider socio-economic policies. Men can’t make healthy choices if the work they do – or don’t do – and the social and economic structures within which they live prevent them.’

The EU-commissioned State of Men’s Health in Europe brings together the official epidemiological data from across Europe and across all major disease areas from cancer and heart disease to mental health. The Report’s lead author Professor Alan White of Leeds Metropolitan University in England said:   ‘For the first time we have a clear picture of men’s health across the EU.  Previously we had a series of partial pictures by country or disease area. This brings it all together so that policy-makers at all levels across Europe can see exactly what they’re dealing with and learn from each other.

Let’s make no mistake, it can be done. To give one example, if every country had the accident rate of the Netherlands we’d save 100,000 lives a year.’

The Report makes a strong business case for keeping men alive. ‘This is not just about health,’ said Dr Banks. ‘Premature male death undermines the economy, undermines families, undermines women and their health and undermines our social security and health services.’

‘Europe will have far fewer men of working age in the years to come so if we’re to succeed economically we need them to be in decent health.’

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• Mortality rates jump between early and late adolescence.
• Rates of death by injury between ages 15 to 19 are about six times that of the rate between ages 10 and 14.
• Crime rates are highest among young males and rates of alcohol abuse are high relative to other ages.

Even though most adolescents come through this transitional relatively well, it’s important to understand the risk factors for behavior that can have serious consequences. Genes, childhood experience, and the environment in which a young person reaches adolescence all shape behavior. Adding to this complex picture, research is revealing how all these factors act in the context of a brain that is changing, with its own impact on behavior.

Powerful new technologies have enabled researchers to track the growth of the brain and to investigate the connections between brain function, development, and behavior.

The research has turned up some surprises, among them the discovery of striking changes taking place during the teen years. These findings have altered long-held assumptions about the timing of brain maturation. In key ways, the brain doesn’t look like that of an adult until the early 20s.

The more we learn, the better we may be able to understand the abilities and vulnerabilities of teens, and the significance of this stage for life-long mental health.  The fact that so much change is taking place beneath the surface may be something for parents to keep in mind during the ups and downs of adolescence.

To learn more visit:  http://www.nimh.nih.gov/health/publications/the-teen-brain-still-under-construction/complete-index.shtml