Can you walk off Erectile dysfunction?

Researchers writing in the medical journal Urology examined questionnaires returned by over 15,000 aging men and found that moderate or severe sexual symptoms occurred in 20% of men 40 to 44 years and that significant symptoms increased with age up to 67% in the men 65 to 69 years. 1

Other researchers writing in The Journal of Sexual Medicine examined sexual function in older adults and noted that 41% of the men were sexually active with an average age between 75 and 87 (yes that says 87). The men who were not sexual active reported erectile dysfunction as the main reason why. Regardless the researchers concluded that desire for sexual activity remained high among men, despite substantial problems with erectile dysfunction. 2

Erectile dysfunction

It is important to understand that dysfunction is not an inevitable aspect of getting older. In fact, it’s more of a side effect of lifestyle than aging.

My initial advice to a man wanting to preserve or restore his sexual function is, instead of drugs, tie on your running shoes and start walking or jogging and change your nutrition. The old adage, “You are what you eat” rings true for sexual health and performance. Nutrition and exercise control the entire physiology of your body, and what you eat and do reflects in your ability to perform in bed.

Aging Men, Obesity, Metabolic Syndrome, Decrease in Total Serum Testosterone Levels
Researchers writing in the Journal of Urology say that their study “…demonstrated that aging men with obesity and the metabolic syndrome have a significant decrease in total serum testosterone levels compared to aging, metabolically healthy men.” Read more

Decreased Testosterone and Erectile Dysfunction
Researchers writing in the Journal of Urology say that their study clearly demonstrated a decrease in testosterone level throughout a 4-year follow up in patients with ED. Read more

Diabetes and ED
Researchers writing in the British Journal of Urology say that about 1 in 3 men newly diagnosed with diabetes had ED. Read more

Is Erectile Dysfunction A Marker For Diabetes?
Researchers writing in the Journal of Urology say that male dysfunction was “an observable marker of diabetes mellitus, strongly so for men 45 years old or younger and likely for men 46 to 65 years old, but it is not a marker for men older than 66 years.” Read more

1. Mäkinen JI, Perheentupa A, Raitakari OT, et al. Sexual symptoms in aging men indicate poor life satisfaction and increased health service consumption Urology. 2007 Dec;70(6):1194-9.

2. Smith LJ, Mulhall JP, Deveci S, Monaghan N, Reid MC. Sex after seventy: a pilot study of sexual function in older persons. J Sex Med. 2007 Sep;4(5):1247-53.

Erectile Dysfunction and Diabetes

Researchers writing in the Journal of Urology say that male dysfunction was “an observable marker of diabetes mellitus, strongly so for men 45 years old or younger and likely for men 46 to 65 years old, but it is not a marker for men older than 66 years.”

Sun P, Cameron A, Seftel A, Shabsigh R, Niederberger C, Guay A. Erectile dysfunction–an observable marker of diabetes mellitus? A large national epidemiological study.J Urol. 2006 Sep;176(3):1081-5; discussion 1085
From the study abstract
Read more

Endurance Training and Age-Related Decline in Immune Function and Endocrine Function

Researchers writing in the medical journal Immunity and Ageing say that long-term endurance training has the potential to decelerate the age-related decline in immune function but not the deterioration in endocrine function.

Arai MH, Duarte AJ, Natale VM. The effects of long-term endurance training on the immune and endocrine systems of elderly men: the role of cytokines and anabolic hormones. Immun Ageing. 2006 Aug 25;3:9

From the article abstract:”highly conditioned elderly men seem to have relatively better preserved immune system than the sedentary elderly men. Long-term endurance training has the potential to decelerate the age-related decline in immune function but not the deterioration in endocrine function.”

Hip Fracture in High Risk Groups

Researchers writing in the Journal of Postgraduate Medicine say “prevention of hip fracture is still inadequate in high risk patients. Discrepancy seemed to exist in treatment frequency among different high risk groups suggesting that emphasis on prevention of osteoporosis has not been reinforced in all people at risk.”

Peng EW, Elnikety S, Hatrick NC. Preventing fragility hip fracture in high risk groups: an opportunity missed. Postgrad Med J. 2006 Aug;82(970):528-31

From the study abstract:
OBJECTIVE: The national guideline recommends selective case finding as the main strategy by identification of high risk people. This study assessed whether high risk patients were identified before their presentation with fragility fracture.

METHODS: A prospective study for 3.5 consecutive months on patients with low energy hip fractures to Brighton and Sussex University Hospital NHS Trusts, which serves a population of 460,000. Data were collected by interview using standardised form, medical record review, and communication with family physicians.

Definition of high risk:
(1) untreated hypogonadism
(2) corticosteroid users
(3) disorders with increased bone loss
(4) previous fragility fractures.

RESULTS: 98 patients were admitted with hip fracture. Thirty nine (40%) had at least one high risk factor. High risk patients (7 of 39, 18%) were no more likely to receive prophylaxis compared with patients without high risk factor (5 of 59, 8%) (p = 0.21). Previous fragility fracture (23) was the commonest risk factor followed by disorders with increased bone loss (10), premature menopause (10), and corticosteroid users (5). Fifteen patients (15%) had susceptibility to frequent falls and two had maternal history of osteoporosis. The proportion of treated patients were 20% (2 of 10) in premature menopause, 10% (1 of 10) in diseases with secondary osteoporosis, 13% (3 of 23) in previous fragility fracture, and 80% (4 of 5) in corticosteroid users (p = 0.01)

CONCLUSION: Prevention of hip fracture is still inadequate in high risk patients. Discrepancy seemed to exist in treatment frequency among different high risk groups suggesting that emphasis on prevention of osteoporosis has not been reinforced in all people at risk.

Osteoporosis in Men

Testosterone and Estradiol Deficiency
Researchers writing in the Journal of Clinical Endocrinology & Metabolism say that: Older men with total testosterone or estradiol deficiency were more likely to be osteoporotic. Those with osteoporosis were more likely to be total testosterone or estradiol deficient. Rapid hip bone loss was more likely in men with total testosterone deficiency.

Fink HA, Ewing SK, Ensrud KE, Barrett-Connor E, Taylor BC, Cauley JA, Orwoll ES. Association of Testosterone and Estradiol Deficiency with Osteoporosis and Rapid Bone Loss in Older Men. J Clin Endocrinol Metab. 2006 Jul 18

From the article abstract:
Context: The clinical value of measuring testosterone and estradiol in older men with osteoporosis and of measuring bone mineral density (BMD) in older men with testosterone or estradiol deficiency is uncertain.

Objective: To examine the association of testosterone and estradiol deficiency with osteoporosis and rapid bone loss in older men.

Participants: 2447 community-dwelling men aged >/=65.

Main Outcome Measures: Total testosterone deficiency defined as <200 ng/dl.

Total estradiol deficiency defined as <10 pg/ml.

Results: Prevalence of osteoporosis in men with deficient and normal total testosterone was 12.3% and 6.0% (P = 0.003), and in those with deficient and normal total estradiol was 15.4% and 2.8% (P < 0.0001).

Among osteoporotic men and those with normal BMD, prevalence of total testosterone deficiency was 6.9% and 3.2% (P = 0.01) and prevalence of total estradiol deficiency was 9.2% and 2.4% (P = 0.0001). Incidence of rapid hip bone loss in men with deficient and normal total testosterone was 22.5% and 8.6% (P = 0.007), and in those with deficient and normal total estradiol was 14.3% and 6.3% (P = 0.08).

Conclusions: Older men with total testosterone or estradiol deficiency were more likely to be osteoporotic. Those with osteoporosis were more likely to be total testosterone or estradiol deficient. Rapid hip bone loss was more likely in men with total testosterone deficiency. BMD testing of older men with sex steroid deficiency may be clinically warranted.

Aging Men and Their Hormones

Writing in the medical journal Minerva Ginecologica, researchers say that “The ability to maintain active and independent living for as long as possible is a crucial factor for (aging healthfully)” and that “Interventions such as hormone replacement therapy may alleviate the debilitating conditions of secondary partial endocrine deficiencies by preventing the preventable and delaying the inevitable.”

Lunenfeld B. Endocrinology of the aging male. Minerva Ginecol. 2006 Apr;58(2):153-70.

From the study abstract:
“Despite enormous medical progress during the past few decades, the last years of life are still accompanied by increasing ill health and disability.

The ability to maintain active and independent living for as long as possible is a crucial factor for ageing healthily and with dignity. The most important and drastic gender differences in aging are related to the reproductive organs. In distinction to the course of reproductive ageing in women, with the rapid decline in sex hormones expressed by the cessation of menses, men experience a slow and continuous decline. This decline in endocrine function involves: a decrease of testosterone, dehydroepiandrosterone (DHEA), oestrogens, thyroid stimulating hormone (TSH), growth hormone (GH), IGF1, and melatonin.

The decrease of sex hormones is concomitant with a temporary increase of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). In addition sex hormone binding globulins (SHBG) increase with age resulting in further lowering the concentrations of free biologically active androgens.

These hormonal changes are directly or indirectly associated with changes in body constitution, fat distribution (visceral obesity), muscle weakness, osteopenia, osteoporosis, urinary incontinence, loss of cognitive functioning, reduction in well being, depression, as well as sexual dysfunction.

The laboratory and clinical findings of partial endocrine deficiencies in the aging male will be described and discussed in detail. With the prolongation of life expectancy both women and men today live 1/3 of their life with endocrine deficiencies. Interventions such as hormone replacement therapy may alleviate the debilitating conditions of secondary partial endocrine deficiencies by preventing the preventable and delaying the inevitable.”

Article Notes:
Luteinizing hormone is produced in the pituary gland and helps regulate the production of testosterone.
Follicle-stimulating hormone is produced in the pituary gland and helps regulate the production of sperm.

Predicting Mortality: Researchers Have A Formula

Lee SJ, Lindquist K, Segal MR, Covinsky KE, Development and Validation of a Prognostic Index for 4-Year Mortality in Older Adults. JAMA. 2006;295:801-808.

From the Journal of the American Medical Association (JAMA)
ABSTRACT: “Context Both comorbid conditions and functional measures predict mortality in older adults, but few prognostic indexes combine both classes of predictors. Combining easily obtained measures into an accurate predictive model could be useful to clinicians advising patients, as well as policy makers and epidemiologists interested in risk adjustment.

Objective: To develop and validate a prognostic index for 4-year mortality using information that can be obtained from patient report.

Results:…Twelve independent predictors of mortality were identified: 2 demographic variables (age: 60-64 years, 1 point; 65-69 years, 2 points; 70-74 years, 3 points; 75-79 years, 4 points; 80-84 years, 5 points, >85 years, 7 points and (being male), 2 points), 6 comorbid conditions (diabetes, 1 point; cancer, 2 points; lung disease, 2 points; heart failure, 2 points; current tobacco use, 2 points; and body mass index <25, 1 point), and difficulty with 4 functional variables (bathing, 2 points; walking several blocks, 2 points; managing money, 2 points, and pushing large objects, 1 point. Scores on the risk index were strongly associated with 4-year mortality in the validation cohort, with 0 to 5 points predicting a less than 4% risk, 6 to 9 points predicting a 15% risk, 10 to 13 points predicting a 42% risk, and 14 or more points predicting a 64% risk….

Conclusion: This prognostic index, incorporating age, sex, self-reported comorbid conditions, and functional measures, accurately stratifies community-dwelling older adults into groups at varying risk of mortality.

Aging

Researchers look at what makes people age successfully
Factors associated with the successful aging of the socially-active elderly in the metropolitan region of Porto Alegre. Rev Bras Psiquiatr. 2005 Dec;27(4):302-308. Moraes JF, Souza VB.

Writing in the medical journal Revista Brasileira de Psiquiatria, researchers studied some of the inhabitants of the metropolitan region of the Brazialian city Porto Alegre. What they sought to do was “identify the factors associated with aging of the socially-active elderly in the metropolitan region of Porto Alegre.” Read more

Predicting Mortality: Researchers Have A Formula
From the Journal of the American Medical Association (JAMA)
ABSTRACT: “Context Both comorbid conditions and functional measures predict mortality in older adults, but few prognostic indexes combine both classes of predictors. Combining easily obtained measures into an accurate predictive model could be useful to clinicians advising patients, as well as policy makers and epidemiologists interested in risk adjustment. Read more

Researchers Say Marital Strain Can Affect Aging
You make me sick: marital quality and health over the life course. Umberson D, Williams K, Powers DA, Liu H, Needham B.J Health Soc Behav. 2006 Mar;47(1):1-16.

From the press release of the American Sociological Association:
“Researchers have found that marital strain accelerates the typical decline in self-rated physical health that occurs over time and that this adverse effect is greater at older ages. As men and women age, they become increasingly vulnerable to marital stress, according to a team of sociologists from the University of Texas-Austin and Ohio State University. Their findings appear in an article on marital quality and health over the life course in this month’s Journal of Health and Social Behavior, a publication of the American Sociological Association.”

Click here to go to our links page for the press release from American Sociological Association

Aging Men and Their Hormones
Writing in the medical journal Minerva Ginecologica, researchers say that “The ability to maintain active and independent living for as long as possible is a crucial factor for (aging healthfully)” and that “Interventions such as hormone replacement therapy may alleviate the debilitating conditions of secondary partial endocrine deficiencies by preventing the preventable and delaying the inevitable.”

Why Do Some People Age Healthily and Happily, While others do not?
Coping with Stress and Adversity May Be A Key

Arizona State University researchers will begin a five year study to examine how “factors of risk and resilience contribute to health and well-being.” Read more

Male and Female Intimacy Dysfunctions

Researchers writing in the medical journal Lancet report on endocrine disease and male and female intimacy dysfunctions.

Bhasin S, Enzlin P, Coviello A, Basson R. Sexual dysfunction in men and women with endocrine disorders. Lancet. 2007 Feb 17;369(9561):597-611

Endocrine disease frequently interrupts sexual function, and sexual dysfunction may signal serious endocrine disease. Diabetic autonomic neuropathy and endothelial dysfunction impair erectile function, and phosphodiesterase inhibition produces only moderate benefit. The effect of diabetes on women’s sexual function is complex: the most consistent finding is a correlation between sexual dysfunction and depression. Reductions in testosterone level in men are associated with low sexual desire and reduced nocturnal erections and ejaculate volume, all of which improve with testosterone supplementation. The age-dependent decline in testosterone production in men is not associated with precise sexual symptoms, and supplementation has not been shown to produce sexual benefit. In women, sexual dysfunction has not been associated with serum testosterone, but this may be confounded by limitations of assays at low concentrations and by the greater importance of intracellular production of testosterone in women than in men. Testosterone supplementation after menopause does improve some aspects of sexual function in women, but long-term outcome data are needed. More research on the sexual effects of abnormal adrenal and thyroid function, hyperprolactinaemia, and metabolic syndrome should also be prioritised. We have good data on local management of the genital consequences of oestrogen lack, but need to better understand the potential role of systemic oestrogen supplementation from menopause onwards in sexually symptomatic women.

Testosterone and Muscle Strength in the Elderly

Researchers writing in the Journal of the American Geriatric Society suggest that testosterone/DHT therapy may produce a moderate increase in muscle strength in men age 65 and over.

Ottenbacher KJ, Ottenbacher ME, Ottenbacher AJ, Acha AA, Ostir GV. Androgen treatment and muscle strength in elderly men: A meta-analysis. J Am Geriatr Soc. 2006 Nov;54(11):1666-73

The researchers reviewed published, randomized trials examining the effect of androgen treatment (Testosterone or dihydrotestosterone (DHT)) on muscle strength in older men age 65 and over.

What they found was: “larger effects for measures of lower extremity muscle strength than for upper extremity muscle strength” and “injected than topical or oral administration of testosterone/DHT.”

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