The prostate,men and men's health

Benign prostatic hyperplasia (BPH) is the most prevalent disease in the ageing male and the incidence of symptomatic disease is likely to increase in the millenium with increased life expectancy. BPH can have a severe impact on quality of life, including sexual function, and yet many men do not seek medical attention for this and many other diseases. Surgery is no longer a mandatory treatment for BPH. Medical management can provide excellent symptom relief and improvement in urinary flow rates, as well as quality of life, and men need to be made aware of this in order to make informed treatment decisions. In the broader context, men should be encouraged to become more health conscious and develop a more positive attitude towards their health.     

Anemia,testosterone, and pituitary adenoma in men

OBJECT: Older men with clinically nonfunctioning pituitary tumors have been noted to be anemic, to have hypopituitarism, and to have low serum levels of testosterone. The authors hypothesized that men with pituitary adenomas and hypogonadism have a physiologically related decrease in hematocrit. METHODS: A retrospective analysis was conducted of 216 patients older than 50 years of age who harbored pituitary adenomas. In 100 men serum testosterone levels and a complete blood (cell) count (CBC) were obtained before treatment; a CBC was also acquired in a series of women with pituitary adenomas. Using clinical laboratory standards, anemia was defined as a hematocrit less than 40% in men and less than 35% in women. Thirty-one (46.3%) of 67 men with low serum concentrations of testosterone were anemic. In men with low levels of testosterone, the average hematocrit was 39.9%, compared with 45.6% for men with normal testosterone levels (p < 0.001). Men with macroadenomas were most likely to have both anemia and a low serum concentration of testosterone. Anemia was associated with a low level of testosterone, adjusting for tumor size (odds ratio 19, 95% confidence interval 4.86-77.03). Of patients with anemia, 84% were men and 16% were women (p < 0.001). The prevalence of anemia in women was low and was not correlated with tumor size. Men receiving testosterone replacement therapy had a significantly higher hematocrit value than men with low or normal testosterone levels. CONCLUSIONS: These findings support a direct relationship between serum testosterone levels and hematopoiesis in men, and demonstrate that hematopoiesis is compromised in men who have low concentrations of testosterone due to a pituitary adenoma.     

Stigma,access to healthcare,and HIV risks among men who sell sex to men in Nigeria

Introduction : Among men who have sex with men (MSM), men who sell sex (MSS) may be subject to increased sexual behaviour‐related stigma that affects uptake of healthcare and risk of sexually transmitted infections (STIs). The objectives of this study were to characterize stigma, access to care, and prevalence of HIV among MSS in Nigeria. Methods : Respondent‐driven sampling was used to recruit MSM in Abuja and Lagos into the ongoing TRUST/RV368 study, which provides HIV testing and treatment. Detailed behavioural data were collected by trained interviewers. MSS were identified by self‐report of receiving goods or money in exchange for sex with men. Poisson regression with robust error variance was used to explore the impact of sex‐selling on the risk of HIV. Results : From 12 initial seed participants, 1552 men were recruited from March 2013‐March 2016. Of these, 735 (47.4%) reported sex‐selling. Compared to other MSM, MSS were younger (median 22 vs. 24 years, p < 0.001) and more likely to identify as gay/homosexual (42.4% vs. 31.5%, p < 0.001). MSS were more likely to report perceived and experienced stigmas such as healthcare avoidance (27.6% vs. 21.5%, p = 0.005) and verbal harassment (39.2% vs. 26.8%, p < 0.001). Total HIV prevalence was 53.4%. After controlling for other factors, HIV prevalence among MSS was similar to that observed among other MSM (relative risk 0.94 [95% confidence interval 0.84–1.05]). Conclusions : These data highlight increased sexual behaviour‐related stigma affecting MSS, as compared with other MSM, that limits uptake of healthcare services. The distinct characteristics and risks among MSS suggest the need for specific interventions to optimize linkage to HIV prevention and treatment services in Nigeria.     

Bone density, geometry, and fracture in elderly men

Bone geometry is a major determinant of the mechanical resistance of bone. Mechanical strength of the vertebrae depends on the cross-sectional area of the vertebral body and on the size of the posterior arch. Smaller bone width is associated with higher risk of stress fracture. A longer femoral neck axis and a more open neck-shaft angle are associated with higher risk of cervical hip fracture. No consistent association between the femoral neck width and the cervical fracture risk was found. Areal bone mineral density (aBMD) is not a good tool for the identification of elderly men with high fracture risk. Fracture risk increases with decreasing aBMD, but only a minority of men who will sustain an osteoporotic fracture are identified by a given threshold of baseline aBMD. Bone width seems to be an independent predictor of the fracture risk in elderly men, and its assessment can improve the prediction of fractures in this population.     

Prevalence and correlates of HIV among men who have sex with men in Tijuana,Mexico

Introduction

Men who have sex with men (MSM) in developing countries such as Mexico have received relatively little research attention. In Tijuana, Mexico, a border city experiencing a dynamic HIV epidemic, data on MSM are over a decade old. Our aims were to estimate the prevalence and examine correlates of HIV infection among MSM in this city.

Methods

We conducted a cross-sectional study of 191 MSM recruited through respondent-driven sampling (RDS) in 2012. Biological males over the age of 18 who resided in Tijuana and reported sex with a male in the past year were included. Participants underwent interviewer-administered surveys and rapid tests for HIV and syphilis with confirmation.

Results

A total of 33 MSM tested positive for HIV, yielding an RDS-adjusted estimated 20% prevalence. Of those who tested positive, 89% were previously unaware of their HIV status. An estimated 36% (95% CI: 26.4–46.5) had been tested for HIV in the past year, and 30% (95% CI: 19.0–40.0) were estimated to have ever used methamphetamine. Independent correlates of being infected with HIV were methamphetamine use (odds ratio [OR]=2.24, p=0.045, 95% CI: 1.02, 4.92) and active syphilis infection (OR=4.33, p=0.01, 95% CI: 1.42, 13.19).

Conclusions

Our data indicate that MSM are a key sub-population in Tijuana at higher risk for HIV. Tijuana would also appear to have the highest proportion among upper-middle-income countries of HIV-positive MSM who are unknowingly infected. More HIV prevention research on MSM is urgently needed in Tijuana.     

Primary bladder neck obstruction in men,women, and children

The understanding of the presentation, diagnosis, and treatment of primary bladder neck obstruction (PBNO) has evolved over the last 20 years. It was first identified 70 years ago, but the etiology is still unclear. There are multiple theories as to the etiology, including muscular and neurological dysfunction and fibrosis. Over the years, many voiding parameters and cut points and nomograms have been presented for diagnosis of nonneurogenic functional bladder outlet obstruction in young men. Until recently, there was a paucity of data on PBNO in women and children. Videourodynamics provide an accurate diagnosis of PBNO but for some patients are an invasive option. Treatments vary from watchful waiting to α-blockade to surgery, depending on the severity of symptoms, urodynamic findings, and response to medical therapy. This paper reviews the theories on etiology, incidence, presentation, and diagnostic evaluation, and briefly discusses treatment options for PBNO.     

Estrogen and bone: insights from estrogen-resistant, aromatase-deficient, and normal men

Findings from estrogen-resistant and aromatase-deficient men have provided important insights into the role of estrogen in the male skeleton during growth. Importantly, as reported elsewhere in this issue, these data also suggested dose-response relationships between estrogen and bone turnover. In addition, studies in these unusual patients have stimulated research on defining the role of estrogen in regulating bone metabolism in normal adult and aging men, providing further insights into estrogen regulation of bone metabolism not only in men, but also in women.     

Life expectancy, antagonistic pleiotropy, and the testis of dogs and men

BACKGROUND: Prostate cancer and benign prostatic hyperplasia are important age-related prostatic diseases that are under the influence of testicular hormones. However, the disparity between male and female life expectancy within the human population cannot be explained solely by the prevalence of prostatic disease-related mortality. The purpose of this paper is to explore the possibility that the testis exerts a detrimental effect on life span. METHODS: First, we review previously published and unpublished data on the influence of the testis on the life span of dogs and men. Aging in pet dogs and men is then discussed in terms of evolutionary theory, emphasizing the significance of a prolonged postreproductive life span and possible consequences of late-acting deleterious genes in these two species. Finally, we present preliminary data that orchiectomy can reduce DNA damage within the brain of elderly male dogs. RESULTS AND CONCLUSIONS Taken together, these observations raise the intriguing possibility that interventions to antagonize the testis might have much broader therapeutic applications that will extend well beyond the treatment of prostate cancer.     

Effects of ibuprofen, naproxen, and sulindac on prostaglandins in men

In contrast to other nonsteroidal anti-inflammatory drugs (NSAIDs), sulindac has been reported to inhibit systemic prostaglandins (PGs) while not affecting renal PGs. We studied 11 normal volunteers who received placebo, ibuprofen, naproxen, or sulindac in a randomized, double-blind fashion. After control periods assessing the effect of the NSAIDs alone, 40 mg of furosemide were administered. Overall, each of the drugs appeared similar. Renal function, plasma renin activity (PRA) and urinary PGs were not affected during control collections, while all three NSAIDs decreased thromboxane B2 (TxB2). After furosemide, all NSAIDs decreased fractional excretions of Na+ and Cl-, PRA, and TxB2 by equivalent degrees (P less than 0.05). Sulindac and ibuprofen decreased urinary PGE2 (P less than 0.05) while naproxen had no effect. None of these drugs affected the excretion of furosemide, but all decreased the pharmacodynamics of response to furosemide. In conclusion, the effects of these NSAIDs depended on the conditions of the study. In the basal state there were no renal effects but all decreased the renal response to furosemide.     

Cadmium, lead, selenium, and zinc in semen of occupationally unexposed men

Summary. Concentrations of cadmium, lead, selenium, and zinc were determined in semen and seminal plasma of 22 volunteers by atomic absorption spectrometry. Additionally conventional semen parameters and, by means of computer videomicrography, motion parameters of spermatozoa were evaluated. Concentrations of Cd, Pb, and Zn determined in semen were not significantly different from those measured in seminal plasma. However, selenium levels were significantly higher in semen (53.8 ± 22.9 μg 1⁻¹) than in seminal plasma (40.4 ± 15.5 μg 1⁻¹, P <0.01). The investigated semen samples on average contained low levels of Cd (0.4 ± 0.23 μg 1⁻¹) and Pb (9.8 ± 6.5 μg 1⁻¹). Studies on the intra-individual variability revealed the following average coefficients of variation (%) for element concentrations: Pb (70), Cd (53), Se (27), and Zn (23); and for semen parameters: total sperm count (46), sperm concentration (37), motility (22), ejaculate volume (21), linearity (19), linear velocity (11), curvilinear velocity (10), and percentage of normally formed sperm (9). Significant positive correlations were detected between semen selenium levels and sperm concentration ( r =0.51, P <0.05), and percentage of normally formed sperm ( r =0.46, P <0.05), respectively. Sperm motility ( r =0.53, P <0.02), linear ( r = 0.76, P <0.001) and curvilinear velocity ( r = 0.64, P < 0.002) were significantly correlated with semen cadmium levels.     

Diagnostic evaluation, classification, and treatment of men with sexual dysfunction

During a two-year period, 165 men were evaluated for sexual dysfunction. Most evaluations were conducted on an outpatient basis and required two separate visits. Fifty-one per cent, 47 per cent, and 2 per cent of the patients were found to have functional disorders, organic disorders, and incomplete evaluations, respectively. Treatment recommendations were tailored to each patient using information gathered during the diagnostic evaluation.     

Willingness to use HIV pre‐exposure prophylaxis among gay men,other men who have sex with men and transgender women in Myanmar

Introduction : HIV pre‐exposure prophylaxis (PrEP) has emerged as a key component of contemporary HIV combination prevention strategies. To explore the local suitability of PrEP, country‐specific acceptability studies are needed to inform potential PrEP implementation. In the context of Myanmar, in addition to resource constraints, HIV service access by gay men, other men who have sex with men, and transgender women (GMT) continues to be constrained by legislative and community stigma and marginalization. We aimed to determine PrEP acceptability among GMT in Myanmar and explore the factors associated with willingness to use PrEP. Methods : GMT were recruited in Yangon and Mandalay through local HIV prevention outreach programmes in November and December 2014. Quantitative surveys were administered by trained peer educators and collected data on demographics, sexual risk, testing history and PrEP acceptability. A modified six‐item PrEP acceptability scale classified self‐reported HIV undiagnosed GMT as willing to use PrEP. Multivariable logistic regression identified factors associated with willingness to use PrEP. Results : Among 434 HIV undiagnosed GMT, PrEP awareness was low (5%). PrEP acceptability was high, with 270 (62%) GMT classified as willing to use PrEP. GMT recruited in Mandalay (adjusted odds ratio (aOR) = 1.79; 95%CI = 1.05–3.03), who perceived themselves as likely to become HIV positive (aOR = 1.82; 95%CI = 1.10–3.02), who had more than one recent regular partner (aOR = 2.94; 95%CI = 1.41–6.14), no regular partners (aOR = 2.05; 95%CI = 1.10–3.67), more than five casual partners (aOR = 2.05; 95%CI = 1.06–3.99) or no casual partners (aOR = 2.25; 95%CI = 1.23–4.11) were more likely to be willing to use PrEP. The association between never or only occasionally using condoms with casual partners and willingness to use PrEP was marginally significant (aOR = 2.02; 95%CI = 1.00–4.10). GMT who reported concern about side effects and long‐term use of PrEP were less likely (aOR = 0.35; 95%CI = 0.21–0.59) to be willing to use PrEP. Conclusions : This is the first study to assess PrEP acceptability in Myanmar. Findings suggest PrEP is an acceptable prevention option among GMT in Myanmar, providing they are not required to pay for it. Implementation/demonstration projects are needed to explore the feasibility and cost‐effectiveness of PrEP as a prevention option for GMT in Myanmar.     

Non-condylomatous, perianal disease in homosexual men

This retrospective study details the findings and outcome in 34 homosexual men, out of a total of 177 patients, who underwent surgery for non-condylomatous perianal disease over a 2-year period. Of 34 homosexuals 20 presented with anorectal sepsis compared with 11 of 79 heterosexual male patients (X2 = 24.07, P less than 0.001). Lesions included chronic intersphincteric abscess (eight patients), anal fistula (seven patients) and chronic intersphincteric abscess and fistula (five patients). Anal fissure occurred in 15 patients, anal ulcer in three, skin tags in six, haemorrhoids in two and Kaposi's sarcoma in one. Eight patients were human immunodeficiency virus (HIV) antibody negative, four were asymptomatic HIV antibody positive, 12 had symptomatic HIV infection using the Centers for Disease Control classification and in ten patients HIV status was unknown. Irrespective of the type of surgery performed, healing occurred within 6 weeks of operation in all HIV antibody negative patients, all asymptomatic HIV antibody positive and in only one of nine patients with symptomatic HIV infection. Eight of nine patients with symptomatic HIV infection failed to heal by this time (X2 = 8.98, P less than 0.05). These findings suggest that the prevalence of anorectal sepsis in homosexual men is high and that symptomatic HIV infection is an important determinant of progress after surgery.     

Body composition, metabolic syndrome and testosterone in ageing men

The ageing process in men is marked by changes in body composition (loss of fat-free mass (FFM) and skeletal muscle, and gain in fat mass (FM)) and is associated with a decline in serum testosterone. Correlations between these aspects of ageing and the acknowledged role of exogenous testosterone in reversing the loss of FFM and gain in FM seen in adult men with congenital or acquired hypoandrogenism have led to the hypothesis that testosterone therapy in ageing men will result in favourable changes in body composition and may improve metabolic status and/or cardiovascular risk. Data from randomized controlled trials of testosterone therapy in ageing men addressing the endpoints of body composition and components of the metabolic syndrome and cardiovascular risk factors are reviewed, and the impact of the increasing prevalence of obesity on these relationships is considered.     

Dietary macronutrients, cholesterol, and sodium and lower urinary tract symptoms in men

Background

Little is known about dietary correlates of lower urinary tract symptoms (LUTS).

Objective

To examine associations between dietary intakes of total energy, carbohydrates, protein, fats, cholesterol, and sodium and LUTS in men.

Design, setting, and participants

Cross-sectional study of 1545 men aged 30–79 yr in the Boston Area Community Health survey (2002–2005), a random population-based sample. Dietary data were assessed by validated self-administered food frequency questionnaire. LUTS and covariate data were collected during in-person interviews. Primary analyses used multivariate logistic regression.

Measurements

Outcomes were moderate to severe LUTS, storage symptoms, and voiding symptoms as measured by the American Urological Association Symptom Index.

Results and limitations

Greater total energy intake was associated with higher LUTS symptom score (p_trend < 0.01) and increased likelihood of storage symptoms. No associations were observed with total, saturated, or monounsaturated fat intake or carbohydrates. Men who consumed more protein were less likely to report LUTS, particularly voiding symptoms (quintile 5 vs quintile 1 OR = 0.35; 95% CI, 0.17–0.74; p = 0.006). Sodium intake had positive linear associations with LUTS (p_trend = 0.01) and storage symptom score (p_trend = 0.004); this finding should be confirmed by studies using biomarkers of sodium exposure. Storage symptoms increased slightly with greater polyunsaturated fat intake (p_trend = 0.006). Data on specific polyunsaturated fats were unavailable.

Conclusions

This community-based study of men found that total energy and sodium intake were positively associated with LUTS, whereas greater protein intake was inversely associated with LUTS.     

Occupational cadmium exposure and calcium excretion,bone density,and osteoporosis in men

Exposure to cadmium has been associated with osteoporosis and fracture risk in women and the elderly, but studies in middle‐aged men are lacking. In 83 male (ex)workers (mean age 45 years; range 24 to 64 years) in a radiator factory using cadmium‐containing solder, we investigated the association between urinary cadmium excretion (as an index of lifetime body burden); bone mineral density (BMD) in the distal forearm, hip, and lumbar spine (by dual‐energy X‐ray absorptiometry); and urinary calcium excretion. Geometric mean urinary cadmium concentration was 1.02 µg/g of creatinine (5th to 95th percentile 0.17 to 5.51 µg/g). BMD was negatively correlated with urinary exposure to cadmium. The partial correlation coefficients (r) adjusted for age, body‐mass index, and current smoking were ?0.30 (p = .008) for BMD in the forearm, ?0.27 (p = .017) in the hip, and ?0.17 (p = .15) in the spine. Urinary calcium correlated positively (r = 0.23, p = .044) with the urinary cadmium excretion. Adjusted for the same covariates, the risk of osteoporosis (defined as a T‐score below ?2.5 in at least one measured bone site) increased dose dependently. Compared with the lowest tertile of urinary cadmium, the risks were 4.8‐ and 9.9‐fold higher in the middle and highest tertiles, respectively. Only four (5%) men had evidence of renal tubular dysfunction (β₂‐microglobulin > 300 µg/g of creatinine). Even in the absence of renal tubular dysfunction, occupational exposure to cadmium is associated in men with lower BMD values, a higher risk of having osteoporosis, and a higher urinary calcium excretion, suggesting a direct osteotoxic effect of cadmium. © 2010 American Society for Bone and Mineral Research     

Production, clearance, and metabolism of testosterone in men with prostatic cancer

It was previously unknown whether the production and metabolism of testosterone was altered in men with prostatic cancer. We recently observed a familial influence on the plasma concentration of sex steroids in men with the cancer. We have now determined, by isotope dilution techniques, the blood testosterone production and clearance rates and testosterone metabolism to potent androgen metabolites in men with prostatic cancer, their brothers, and unrelated controls. Nineteen men had a diagnosis of prostatic cancer before age 63 (probands), 23 were brothers of these index cases, and nine controls matched for age were selected randomly from the general population. None had received endocrine therapy. The plasma content of testosterone, dihydrotestosterone, sex hormone binding globulin, apparent free testosterone concentration, follicle-stimulating hormone, and luteinizing hormone were not significantly different between the groups. The metabolic clearance rate of testosterone was significantly (P = .04) higher in probands (458 liters/day/body surface area, median) than in controls (306 liters/day/body surface area). The conversion ratios of both testosterone (1.8%) and dihydrotestosterone (16.9%) to 3 alpha-androstanediol were significantly greater (P = .04 and P = .004, respectively) in probands than in controls (0.95%, 7.8%). These results indicate that men with prostatic cancer have elevated clearance rates of testosterone and an increased conversion ratio of testosterone to its potent 5 alpha-reduced metabolites.