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Recent Literature in Sexual Medicine/ Andrology

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Recent Literature in Sexual Medicine/ Andrology 1 December 2010 Recent Literature in Sexual Medicine/ Andrology Original Research Prevalence of Sexual Activity and Associated Factors in Men Aged 75 to 95 Years A Cohort Study Zoë Hyde, MPH; Leon Flicker, MBBS, PhD; Graeme J. Hankey, MD; Osvaldo P. Almeida, MD, PhD; Kieran A. McCaul, MPH, PhD; S.A. Paul Chubb, PhD; and Bu B. Yeap, MBBS, PhD + Author Affiliations From Western Australian Centre for Health and Ageing, Centre for Medical Research, Western Australian Institute for Medical Research, School of Medicine and Pharmacology, School of Psychiatry and Clinical Neurosciences, University of Western Australia, Crawley; Royal Perth Hospital, Perth; and Fremantle Hospital, Fremantle, Western Australia, Australia. Ann Int Med 2010, publ.online Dec. 6,2010 Abstract Background : Knowledge about sexuality in elderly persons is limited, and normative data are lacking. Objective : To determine the proportion of older men who are sexually active and to explore factors predictive of sexual activity. Design: Population-based cohort study. Setting : Community-dwelling men from Perth, Western Australia, Australia. Participants : 3274 men aged 75 to 95 years. Measurements : Questionnaires from 1996 to 1999, 2001 to 2004, and 2008 to 2009 assessed social and medical factors. Sex hormones were measured from 2001 to 2004. Sexual activity was assessed by questionnaire from 2008 to 2009. 2 Results: A total of 2783 men (85.0%) provided data on sexual activity. Sex was considered at least somewhat important by 48.8% (95% CI, 47.0% to 50.6%), and 30.8% (CI, 29.1% to 32.5%) had had at least 1 sexual encounter in the past 12 months. Of the latter, 56.5% were satisfied with the frequency of activity, whereas 43.0% had sex less often than preferred. In cross-sectional analyses, increasing age, partner's lack of interest, partner's physical limitations, osteoporosis, prostate cancer, diabetes, antidepressant use, and β-blocker use were independently associated with reduced odds of sexual activity. Living with a partner and having a non–English- speaking background were associated with increased odds. In longitudinal analyses, higher testosterone levels were associated with increased odds of being sexually active. Other factors were similar to the cross-sectional model. Limitations : Response bias may have influenced findings because sexuality can be a sensitive topic. Attrition may have resulted in a healthier-than-average sample of older men. Conclusion : One half of elderly men consider sex important, and one third report being sexually active. Men's health problems were associated with lack of sexual activity. Key modifiable risk factors include diabetes, depression, and medication use. Endogenous testosterone levels predict sexual activity, but the role of testosterone therapy remains uncertain. Primary Funding Source : National Health and Medical Research Council of Australia. Editorial Comment by the ESSM President : Sexuality in the elderly population > 75 years continues to be topic of taboo and therefore reliable reports/studies on that subject are very rarely found in the literature. With that background the authors have to be congratulated to catch up with this taboo topic and provide valid and reliable data on a representative cohort in Australia. Similar to previous reports from Japan and Germany just over ten years ago this study indicates that sexuality remains a topic of interest in about half of this aged male population with nearly half of them being dissatisfied with their current sexual life/performance. One reason more for us, the physicians, seeing and treating this aged population for many other health reasons on a daily basis to overcome our prejudice and to ask even in these aged people about their sexual life and problems. Dihydrotestosterone Administration Does Not Increase Intraprostatic Androgen Concentrations or Alter Prostate Androgen Action in Healthy Men: A Randomized-Controlled Trial Stephanie T. Page*, Daniel W. Lin, Elahe A. Mostaghel, Brett T. Marck, Jonathan L. Wright, Jennifer Wu, John K. Amory, Peter S. Nelson, and Alvin M. Matsumoto 3 Department of Medicine (S.T.P., E.A.M., J.W., J.K.A., P.S.N., A.M.M.) and Department of Urology (D.W.L., J.L.W.), University of Washington, Seattle, Washington 98195; Division of Public Health Sciences (D.W.L.) and Division of Human Biology and Clinical Research (E.A.M., P.S.N.), Fred Hutchinson Cancer Research Center, Seattle, Washington 98109; and Geriatric Research, Education, and Clinical Center and Department of Medicine (B.T.M., A.M.M.), V.A. Puget Sound Health Care System, Seattle, Washington 98108 To whom correspondence should be addressed. E-mail: [email protected]. Journal of Clinical Endocrinology & Metabolism 2010,publ.online 22 Dec. 2010 Context : Concern exists that androgen treatment might adversely impact prostate health in older men. Dihydrotestosterone (DHT), derived from local conversion of testosterone to DHT by 5-reductase enzymes, is the principal androgen within the prostate. Exogenous androgens raise serum DHT concentrations, but their effects on the prostate are not clear. Objective : To determine the impact of large increases in serum DHT concentrations on intraprostatic androgen concentrations and androgen action within the prostate. Design : Double-blind, randomized, placebo-controlled. Setting : Single academic medical center. Participants : 31 healthy men ages 35–55. Intervention : Daily transdermal DHT or placebo gel. Main Outcome Measures : Serum and prostate tissue androgen concentrations and prostate epithelial cell gene expression after 4 wk of treatment. Results : Twenty-seven men completed all study procedures. Serum DHT levels increased nearly sevenfold, while testosterone levels decreased in men treated with daily transdermal DHT gel but were unchanged in the placebo-treated group (P < 0.01 between groups). In contrast, intraprostatic DHT and testosterone concentrations on d 28 were not different between groups (DHT: placebo = 2.8 ± 0.2 vs. DHT gel = 3.1 ± 0.5 ng/g; T: placebo = 0.6 ± 0.2 vs. DHT gel = 0.4 ± 0.1, mean ± SE). Similarly, prostate volume, prostate-specific antigen, epithelial cell proliferation, and androgen-regulated gene expression were not different between groups. Conclusions : Robust supraphysiologic increases in serum DHT, associated with decreased serum T, do not significantly alter intraprostatic levels of DHT, testosterone, or prostate epithelial cell androgen–regulated gene expression in healthy men. Changes in circulating androgen concentrations are not necessarily mimicked within the prostate microenvironment, a finding with implications for understanding the impact of androgen therapies in men. Editorial Comment by the ESSM President : No question this well designed and well done study is a landmark publication because it shows for the first time that even 4 7fold increased DHT plasma levels do not have any impact on the intraprostatic DHT- and T- levels. This study should take away the fear regarding a potential negative effect of T-replacement therapy on the prostate tissue either with regard to BPH or PCA development from all these many physicians who refuse their hypogonadal patients T-replacement therapy because of those concerns. This elegant study shows in addition that the up to 3fold elevated DHT levels, we sometimes find in our hypogonadal patients after T-gel replacement therapy, may not harm our patients' prostate health because they finally do not translate into intraprostatic DHT and T- levels. Male Sexual Dysfunktion : Basic Research Vasoactive intestinal polypeptide, an erectile neurotransmitter, improves erectile function more significantly in castrated rats than in normal rats Min-Guang Zhang1, Zhou-Jun Shen1,5,*, Cun-Ming Zhang1, Wei Wu2, Ping-Jin Gao3, Shan-Wen Chen4, Wen-Long Zhou1 BJU International 2010, Article first published online: 16 DEC 2010 Keywords: androgen; , vasoactive intestinal polypeptide; , erectile function; ,castration; ,signaling pathway OBJECTIVE Androgen is essential for physiological erection. Vasoactive intestinal polypeptide (VIP) is an important erectile neurotransmitter. While previous studies demonstrated that VIP expression in the penis was androgen-independent, it remains controversial whether androgen has any effect on VIP-mediated erection. The present study aims to investigate the regulatory role of androgen in VIP-mediated erectile effect. MATERIALS AND METHODS Male SD rats were divided into a control group, a castration group, and a castration-with-testosterone-replacement group. Four weeks later, each group was subdivided into low and high-dose VIP subgroups and subjected to intracavernous injection of 0.5 and 2 µg VIP, respectively. Erectile function was tested by recording intracavernosal pressure (ICP) and mean arterial blood pressure (MAP) before and after VIP injection. The expressions of the VIP-receptor (VPAC2), G-protein stimulatory and inhibitory alpha subunits (Gs- , Gi- ), and PDE3A in rat corpus cavernosum (CC) was qualified by real-time PCR and Western blot analysis. 5 RESULTS Castration reduced erectile function while testosterone restored it. VIP improved erectile function in a dose-dependent manner. High-dose VIP significantly enhanced erectile function in castrated rats and there was no difference of ICP/MAP among three groups after injection of high-dose VIP. Low-dose VIP also resulted in a higher improvement of erectile function in castrated rats, although the ICP/MAP was lower in these rats than in the other two groups. VPAC2 and
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