Comprehensive evaluation of androgen replacement therapy in aging Japanese men with late-onset hypogonadism

Abstract

Objective: This study assessed the efficacy and safety of testosterone replacement therapy (TRT) in aging Japanese men with late-onset hypogonadism (LOH).

Methods: This study included 50 (median age: 57.7 years) Japanese men with LOH, who were consecutively enrolled and treated with TRT for at least six months at our institution. We evaluated the following measurements before and after six months of treatment with TRT as follows: blood tests, prostate volume, residual urine volume, self-ratings for International Index of Erectile Function 5 (IIEF-5), International Prostate Symptom Score (IPSS), Self-Rating Depression Scale (SDS), Aging Male Symptom (AMS) and the Medical Outcomes Study 8-item Short-Form health survey (SF-8).

Results: Following six months of TRT, the levels of testosterone, red blood cells, hemoglobin and hematocrit were significantly increased from baseline, while total cholesterol level was significantly decreased from baseline. Furthermore, TRT led to a significant increase in IIEF-5 score and a significant decrease in IPSS score. Of 30 men who were diagnosed with depression at baseline, only 11 men (36.7%) were still suffering from depression after TRT, and SDS scores were significantly decreased from baseline at month six. Treatment with TRT led to a significant decrease in all scores of the AMS scale as well as a significant improvement in all scores of the SF-8 survey, with the exception of the bodily pain score.

Conclusion: These findings suggest that TRT is an effective and safe treatment for aging Japanese men with LOH. TRT improved depressive symptoms as well as health-related quality of life.     

Munchausen Syndrome by Proxy: Another Form of Child Abuse

Munchausen syndrome by proxy (MSbP) was first described by Dr Roy Meadow in 1977 as a form of child abuse in which illnesses are fabricated in a child by a parent, usually the mother. The parent causes the illness in the child or exaggerates symptoms in the child, resulting in unnecessary medical and psychological treatments and hospitalizations (Meadow, 1985). The presentation of children in a variety of ways to different medical institutions often defies detection (Williams, 1986). Extra vigilance and investigative efforts are required to unravel the complexity of the action in the pathogenic family. In recent years, MSbP has been reported with increasing frequency and it is now recognized as more common in the service delivery system than has been previously documented. Medical, psychological and social information are separate pieces of a puzzle which will remain separate without a coordinating body to integrate and complete the overall picture. This paper explores a particular case in the State of New South Wales, where members of the legal, medical, social work and psychology professions collaborated to establish that the child was in need of care and should be removed from the high-risk environment in the family home. This is the first Munchausen case in New South Wales that has proceeded to the Supreme Court. Highlighted are the difficulties involved in identifying the syndrome. It is proposed that a coordinating body is fundamental for collating retrospective medical records and to provide a pivotal point for the various professionals involved to meet, exchange and share discrete information. It is further suggested that the Child Protection Services within the State be made responsible for this function and a standardized and systematic procedure be adopted when encountering cases of possible MSbP.     

Sleep disturbance as a clinical sign for severe hypogonadism: efficacy of testosterone replacement therapy on sleep disturbance among hypogonadal men without obstructive sleep apnea

Objective: The present subanalysis of the EARTH study investigates the effects of one year testosterone replacement therapy (TRT) on sleep disturbance among hypogonadal men without obstructive sleep apnea.

Methods: Sleep disturbance was defined as three or more points in question 4 of the aging males symptoms (AMS) questionnaire. All participants completed the AMS scale, International Prostatic Symptoms Score (IPSS), Sexual Health Inventory for Men (SHIM) and Short Form 36 (SF-36) health survey at baseline and after 12?months. Sexual symptoms were also evaluated based on three AMS subscores (Q15, 16 and 17).

Results: We identified 100 patients with sleep disturbance, of whom 48 (24 each in the TRT and control groups) were ultimately included for analysis. All SF-36 categories , AMS scale, IPSS and SHIM score subdomains were significantly worse in patients with sleep disturbance than in those without disturbance. Statistically significant differences in sleep disturbance, erectile symptoms, sexual desire and some domains of the SF-36 were observed between the TRT and control groups after 12?months.

Conclusion: Sleep disturbance may be one of the clinical signs for severe hypogonadism. Moreover, TRT improved sleep conditions, sexual function and quality of life among hypogonadal men with sleep disturbance.     

Effects of testosterone replacement therapy on hypogonadal men with osteopenia or osteoporosis: a subanalysis of a prospective randomized controlled study in Japan (EARTH study)

Objective: We investigated the effects of testosterone replacement therapy (TRT) on bone mineral density (BMD) among hypogonadal men with osteopenia/osteoporosis.

Methods: From our previous EARTH study population, 74 patients with a clinical diagnosis of osteopenia or osteoporosis and hypogonadism were included in this study, as the TRT (n?=?35) and control (n?=?34) groups. The TRT group was administered 250?mg of testosterone enanthate injection every 4 weeks for 12 months. The BMD, waist circumference, body mass index, body fat percentage, and muscle volume were measured at baseline and at 12 months. Blood biochemical data, including total cholesterol, triglycerides, HDL-cholesterol, hemoglobin A1c, and adiponectin values were also evaluated.

Results: At the 12-month visit, BMD significantly increased in both groups. However, comparisons on changes of parameter values from baseline to the 12-month visit between the TRT and control groups were significantly different in BMD (5.0?±?5.0 vs. 3.0?±?3.2; p?=?.0434) and in adiponectin value (?0.90?±?3.33 vs. 0.10?±?2.04; p?=?.0192). There were no significant changes in other parameters.

Conclusions: TRT for 12 months could improve BMD with a decrease in adiponectin levels among hypogonadal men with osteopenia/osteoporosis.     

Physical activity and nutrition program for adults with metabolic syndrome: Process evaluation

IntroductionThe Vietnam Physical Activity and Nutrition (VPAN) program aimed to improve physical activity and nutrition for adults aged 50–65 years with Metabolic Syndrome in Vietnam. The VPAN program consisted of a range of resources and strategies, including an information booklet, resistance band, face-to-face education sessions, and walking groups. This process evaluation assessed the participation, fidelity, satisfaction, and reasons for completing and not-completing the VPAN.MethodsData were collected by mixed-methods from a sample of 214 intervention participants. Quantitative data were collected via surveys (n = 163); qualitative data via face-to-face exit interviews with intervention program completers (n = 10) and non-completers (n = 10), and brief post education session discussions.ResultsMost participants (87%–96%) reported the program resources and strategies useful, assisting them to increase their physical activity level and improving their diet. The education sessions were the most preferred strategy (97%) with high attendance (>78% of participants). The main reasons for withdrawal were work commitments and being too busy.ConclusionThe evaluation indicated that the program reached and engaged the majority of participants throughout the six-month intervention. The combination of printed resources and face-to-face intervention components was a suitable approach to support lifestyle behavioural change in the Vietnamese population.     

“How Could I Have Done This?” Thoughts of Mothers of Children with Fetal Alcohol Syndrome

Biological mothers of children with fetal alcohol syndrome (FAS) must cope with the struggles of parenting a child with special needs with the knowledge that their children’s problems are due to their alcohol use during pregnancy. Qualitative interviews were conducted by telephone with 11 biological mothers of children with FAS. This group of mothers understood their use of alcohol during pregnancy through reliance on the disease model, inaccurate or incomplete knowledge of the consequences of drinking during pregnancy, the advice of others, and a lack of awareness of the pregnancy.     

Caffeine intake is not associated with serum testosterone levels in adult men: cross-sectional findings from the NHANES 1999–2004 and 2011–2012

Objective: The association of caffeine intake with testosterone remains unclear. We evaluated the association of caffeine intake with serum testosterone among American men and determined whether this association varied by race/ethnicity and measurements of adiposity.

Methods: Data were analyzed for 2581 men (≥20?years old) who participated in the cycles of the NHANES 1999–2004 and 2011–2012, a cross-sectional study. Testosterone (ng/mL) was measured by immunoassay among men who participated in the morning examination session. We analyzed 24-h dietary recall data to estimate caffeine intake (mg/day). Multivariable weighted linear regression models were conducted.

Results: We identified no linear relationship between caffeine intake and testosterone levels in the total population, but there was a non-linear association (p_nonlinearity?p_nonlinearity?≤?.03 both) and only among men with waist circumference <102?cm and body mass index <25?kg/m² (p_nonlinearity?Conclusion: No linear association was identified between levels of caffeine intake and testosterone in US men, but we observed a non-linear association, including among racial/ethnic groups and measurements of adiposity in this cross-sectional study. These associations are warranted to be investigated in larger prospective studies.     

A Different Take on the Big Bang Theory: Examining the Influence of Asperger Traits on the Perception and Attributional Confidence of a Fictional TV Character Portraying Characteristics of Asperger Syndrome

Research shows that media figures can influence the construction of one’s personal and social identity. However, there are few studies that examine representations of stigmatized groups with developmental disorders, such as those with autism spectrum disorders. This research examines the effect of a viewer’s scores on the autism quotient (AQ) and their relationship with homophily and attributional confidence towards Sheldon on The Big Bang Theory, who is suspected of having Asperger’s syndrome (AS). Guided by uncertainty reduction theory the results indicated a positive relationship between the dimensions of the AQ and homophily with Sheldon, and a positive relationship between higher scores on the AQ and attributional confidence towards Sheldon. The implications of identification with fictional television characters for individuals with AS, and the application of the AQ in future research are discussed relative to the current findings.     

行政立法的正当性初探

行政立法是社会发展的产物,它的产生和扩张有其经济、政治、科技等外在原因以及法制发展需要的内在原因。我们无法否定或取消行政立法的存在,但是行政立法确实存在种种弊端,这些弊端是由其自身的性质和特点决定的。我们必须加强对行政立法的监督控制,包括规则控制、程序控制、立法监督和司法监督,促进行政立法权的正当行使。     

身体-主体的缺席与实践美学和后实践美学的共同欠缺

作为实在的活动,实践的承担者只能是身体-主体。离开身体-主体来谈论实践,就无法敞开其实在品格,以实践为原初范畴的美学建构便会处于悬空状态。从这个角度看,实践美学的最大欠缺是对身体-主体的忽略。忽略身体而又强调实践的意义这种自我矛盾的做法不但造就了一系列逻辑悖论,而且使实践美学无法回答许多根本性的美学问题。后实践美学的倡导者虽然力图超越实践美学,但同样未意识到身体-主体的意义,因而也将实践美学的逻辑欠缺带到自身的理论建构中。只有敞开了实践、生存、生命对身体-主体的原始归属关系,我们才能超越实践美学和后实践美学的共同欠缺,建构出圆融的、具有独创性的、富有解释力的汉语美学体系。