Testosterone therapy - what,when and to whom?

Testosterone therapy has been used for more than 60 years in the treatment of male hypogonadism. The classical forms of hypogonadism are comprised of primary testicular failure or insufficient testicular stimulation due to the lack of pituitary gonadotropins. Typical causes of primary hypogonadism are Klinefelter's syndrome, anorchia or acquired disturbances of testicular function. Secondary hypogonadism is characterized by insufficient production of pituitary gonadotropins, due either to pituitary failure or defects at the hypothalamic level. It is unequivocally accepted in clinical practice that any male with inadequately low testosterone production for his age will require androgen therapy. In addition to the classical forms of hypogonadism, the past decade of research has clearly demonstrated that, with increasing age, many men will suffer from decreasing testosterone production. About 15-25% of men over the age of 50 years will experience serum testosterone levels well below the threshold considered normal for men between 20 and 40 years of age. Studies substituting testosterone in elderly men with low serum testosterone have shown that men with clinical symptoms identical to the symptomatology of classical hypogonadism will benefit most from such therapy. Therefore, it is the general consensus to treat men with age-related hypogonadism only when clinical symptoms are present that can be potentially corrected by testosterone administration. Until recently, intramuscular injections of esters, such as testosterone enanthate, have been the mainstay of testosterone therapy. The introduction of testosterone patches has not challenged this approach, since many users of patches suffer from moderate to severe skin reactions. Some oral testosterone formulations have proven to be problematic, as absorption can be variable, bioavailability is frequently poor, due to the first-pass effect of the liver, and frequent administration is often required<citeref rid="b1"><emph>¹</emph></citeref>. Oral testosterone undecanoate avoids, at least partially, the first-pass effect of the liver. However, plasma testosterone levels generally undergo large fluctuations<citeref rid="b2"><emph>²</emph></citeref>. The large fluctuations in serum testosterone levels caused by conventional intramuscular injections result in unsatisfactory shifts in mood and sexual function in some men, which, combined with the frequency of injections, make the intramuscular mode of delivery far from ideal. Recently, a hydroalcoholic gel containing 1% testosterone has proven to be as efficient as a testosterone patch, but with fewer side-effects and a higher grade of patient satisfaction<citeref rid="b3"><emph>³</emph></citeref>^-<citeref rid="b4"></citeref><citeref rid="b5"><emph>⁵</emph></citeref>. Doses of 50-100 mg gel applied once daily on the skin deliver sufficient amounts of testosterone to restore normal hormonal values and correct the signs and symptoms of hypogonadism. The gel has been shown to be effective and successful in patients in the United States, who have benefited from its availability for almost 3 years. In the near future, intramuscular injections of testosterone undecanoate will become commercially available. Such injections have a very favorable pharmacokinetic profile, with one injection every 3 months maintaining serum testosterone well within the normal range. In phase III studies, intramuscular testosterone undecanoate proved to be as efficient as testosterone enanthate, with only one-quarter of the number of injections required and more stable serum testosterone levels. Thus, the new application modes - hydroalcoholic gel (for example, Testogel®, Schering AG, Germany) and intramuscular testosterone undecanoate (Nebido®, Schering AG, Germany) - appear to be the methods of choice in the near future, one being very suitable for hormone therapy in elderly men, the other for long-term substitution in classical forms of hypogonadism.     

Managing expectations in participatory research involving older people: what’s in it for whom?

Participatory research actively engages participants in some or all stages of the research process – from deciding on scope and problem statement to actively collecting data to disseminating results and effecting change. Considering the shifting roles of participants and researchers in participatory ageing research, to the academic, participatory research becomes a venture into project and people management, local politics, consultancy and community building. First, we present a literature overview of the promises and pitfalls of participatory research. Then, drawing on a university initiated participatory study involving older people as co-researchers in a neighbourhood in Groningen, the Netherlands, we discuss the shifting roles and expectations of all of those involved in the participatory research process. We conclude that a central question that requires continuous negotiation in the participatory research process is: what’s in in for whom?     

Migration,technology and care: what happens to the body?

Migration is a social phenomenon impacting upon family life and conceptualisations of care. Simultaneously, technological advances allow families to stay connected. Care issues in the context of disability and aging may affect family relationships and how families develop. What is little understood is how these issues in migrant families affect a ‘family life course’. We use the case of a South African family with a daughter who is deaf and has other impairments. We argue that when communication is foregrounded and other, embodied, aspects of family care are relegated to the background, we lose the opportunity to understand family care patterns. We relate our discussion to broader theoretical questions regarding the body and care in disability studies.     

Leading the debate for the business case for gender equality,perilous for whom?

This research examines how the framing of the business case for gender equality (BCGE) in the European Union (EU) translates in the Irish national context and how different actors have engaged with this framing exercise. A central concern is how gender knowledge is mobilized by different actors as they compete to shape discourse, policy and practice on gender equality. We draw upon theoretical work that has interrogated the relationship between neoliberalism, gender inequality and feminist mobilization before reviewing critical assessments of the BCGE. The primary focus of this paper, having mapped this theoretical debate, is to analyse the role different Irish actors and organizations play in reproducing key frames and to examine the ambiguous or ambivalent engagement of different interest groups with this agenda. In turn, we assess the degree to which the agenda enables or disables structural change in access to power. We explore three case studies through which the BCGE in the EU was reinforced, adapted, resisted and rejected in our discussions, and draw out the constraints, opportunities and outcomes in each. Our first case study, which sets the national context for the following case studies, reviews how the Irish state interacts with the EU to frame gender equality and how it partners with key actors (state feminism and femocrats, private actors and feminist actors) to advance the BCGE. The second case study examines the role of the leading Irish feminist civil society organization (CSO) in the Women on Boards campaign that reinforces the dominant instrumental discourse associated with EU and national framing of gender parity on boards, and the ambiguity of feminists about this campaign. The third case study examines how Irish financial elites symbolically engage with gender parity on boards while simultaneously seeking to veto the implementation of gender representation targets proposed in the EU Capital Directive. It is clear that a degree of instrumentality informs most actors’ framing of BCGE. We also find evidence of how power actors and financial elites, while rhetorically engaging in BCGE and employing it when relevant to develop reputational capital, will seek ultimately to protect the status quo rejecting the governance benefits implied in BCGE. Ultimately, our cases illustrate the potential of the BCGE to support the inclusion of women in governance structures yet demonstrate that engaging with BCGE is perilous for some.     

A review essay: Reconstruction compared to what?

When the War Was Over: The Failure of Self‐Reconstruction in the South, 1865–1867. Dan Carter. Baton Rouge and London: Louisiana State University Press. 1985. 275pp. £15.55.

Crucible of Reconstruction: War, Radicalism, and Race in Louisiana, 1862–1877. Ted Tunnell. Baton Rouge and London: Louisiana State University Press. 1984. 252pp. $25.00.     

Who speaks up to whom? A relational approach to employee voice

We adopt a relational approach to examine the effects of social relations and formal structure on who speaks up to whom about problems at work. Data were collected in a two-wave employee survey in three Dutch preschools. Using exponential random graph modeling, we found significant positive effects of formal structure (recipient's hierarchical level; team co-membership) and good relations between speaker and recipient on the likelihood of voice in a dyad. Speaker's hierarchical level had positive effects, significant in Wave 1. Speaker's degree centrality significantly reduced the likelihood of voice, whereas recipient's degree centrality had no effect.     

Competency requirements for policy gerontologists: what are the essentials?

"Policy gerontologists" are professionals knowledgeable about both public policy and aging. Through a survey of potential employers about the education of these specialists, the authors examined what is desired in terms of knowledge base, skill proficiencies, and behavioral characteristics. Although a solid knowledge of aging policies and the policymaking process are considered essential for policy gerontologists, respondents suggested that communication and political skills as well as the ability to take initiative and to follow through were also essential.     

Choice: what,when and why? Exploring the importance of choice to disabled people

Extending choice and control over public services is central to current policies in England. Such policies have immense potential for independence and well‐being. However, it is still not clear how disabled people conceptualise choices, what choices are important, for which groups of people, in what areas of life and why. This paper presents findings from the first phase of a longitudinal qualitative study of choice and control over the life‐course. Semi‐structured interviews were carried out with 111 participants including disabled young people with progressive conditions; their parents; adults and older people with fluctuating support needs and those experiencing sudden deterioration in health. The findings suggest that while most people across all study groups wanted to be able to make choices in all areas of their lives, there are significant differences in the importance they attach to specific choices. The findings have implications for service reforms and identify some policy and practice issues that need to be addressed.     

Engagement, but for what kind of marriage?: community members and local planning authorities

In recent years there has been an international trend to encouragegreater participation by community members in making decisionsover local developments. A small study of the experiences ofcommunity activists residing in the City of Moreland (Australia)indicates that existing political and economic structures areneither flexible nor supportive of greater, substantive, democracy.Indeed the kinds of barriers reported at the grassroots suggestthat deep reforms in the traditional patterns of engagementbetween political and bureaucratic authorities and neighbourhoodcommunities are necessary in order to enhance the power of communitymembers. This analysis of community engagement practices drawsa parallel between the multi-various scales of struggles necessitatedfor women's liberation and the breadth of reforms necessaryfor neighbourhood residents to achieve greater power in decisionmaking over local developments.     

Statistical models for causation: what inferential leverage do they provide?

Experiments offer more reliable evidence on causation than observational studies, which is not to gainsay the contribution to knowledge from observation. Experiments should be analyzed as experiments, not as observational studies. A simple comparison of rates might be just the right tool, with little value added by "sophisticated" models. This article discusses current models for causation, as applied to experimental and observational data. The intention-to-treat principle and the effect of treatment on the treated will also be discussed. Flaws in per-protocol and treatment-received estimates will be demonstrated.     

Changing Lives: what is really changing for Scottish social work?

In 2004 the then Scottish Executive launched the 21st Century Social Work Review. The review report, Changing Lives, addressed perceived shortcomings in statutory social work services, claiming to offer a fundamental review of the profession. This paper argues that, rather than offering any significantly new principles or policies, the drift of the Changing Lives process was chiefly to refurnish the discourse in which statutory social work is conducted. Specifically it shifts that discourse away from a long-standing Scottish concern to promote social welfare on a community basis towards an individualised conception of well-being. Central to that process is the Review's advocacy of personalisation of services. It is argued therefore that Changing Lives is best understood as an exercise in the ‘problematics of government’—a reassertion of control by reshaping expectations, rather than a substantive reform of services.     

Sexual professionalism: for whom? The case of sexual facilitation in Swedish personal assistance services

Sexuality is a taboo subject in disability services, leading to insecurity for both service users and personnel about how to handle upcoming situations. In Sweden, there is also a lack of policy in this area, highlighting the need to study sexuality both as an individual and a political, and in this case also, depoliticized issue. A critical feminist policy analysis reveals that norms around disability, sexuality and professionalism in a particular legal, political and cultural context strongly influence the willingness to recognize disabled people’s sexual rights. The Swedish case indicates a need for increased transnational work to develop ethical, professional and non-discriminatory rights-based approaches to sexual facilitation.     

Marriage: for love,for money…and for time?

Married couples enjoy meaningful economies in time, often choosing to specialize where one spouse focuses on market work and the other on household production and childcare. Using data from the American Time Use Survey 2003–2008, I estimate significant marriage effects upon time use. Most married women gain 33–34 min of leisure each weekday when compared to single women. While marriage does not lead to more leisure for husbands, it allows them to allocate time away from home and towards market work. Lower-income couples work more at home and for pay, and spend less time in leisure than their single counterparts. The temporal and financial gains from marriage for most people are inconsistent with its declining prevalence.     

The coping model: what is it and what might be its implications for social work practice?

This article examines whether a coping model developed as a framework for analysis of research interviews is useful in social work practice. The coping model emerged from a study involving qualitative interviews with social service clients in Norway, designed to explore how they coped with challenges in everyday lives, both on an individual level and in interacting with their environment. The model emerged from preliminary analysis and was then used in further analysis of the interview data. The study showed that the informants experienced two major challenges: (1) Unemployment and (2) living with a shortage of money over time, even though their life situations were heterogeneous. Some informants experienced potent coping strategies in finding employment and became independent of social services. Other informants experienced shortages in their capacities for work and continued to be dependent on allowances. They used their coping resources to achieve more meaningful life situations without employment. The coping model represents how coping is understood theoretically in the study and the present paper considers the model's relevance and implications for social work practice itself.