Research Australian scientists: Clinical Picture of Hipodinamism

There is no doubt that androgens affect male sexual function, as well as viagra in Australia in general, and erectile physiology, in particular. ED and hypogonadism co-exist in the same men more frequently than pure causative explanations can justify. Older men have more ED and lower testos-terone, but the two issues are not necessarily causally related. The age-related variation in prevalence of ED is well-known from the Massachusetts Male Aging Study (MMAS) and other epidemiological studies. Clinical practice has verified that older men have more ED, and age is a variable significantly associated with the finding of ED. Age is also a significant factor in predicting serum testosterone, and lower levels of testosterone are found in older men. However, the MMAS found no association between ED and low testosterone, and overall, the prevalence of low serum testosterone in men with docu-mented ED is low.

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The prevalence of hypogonadism in the older age groups is highest—higher than ini-tially suspected. Normal aging results in changes in androgen status and effect through several mechanisms, including alterations in feedback sensitivities; decline in synthetic capacity; changes in serum availability, aging, or responder cells; and interaction with other hormone and regulatory systems (e.g., dihydroepiandrosterone [DHEA], growth hormone, melatonin, and leptin;). There is significant variation in the age at which such changes become apparent as well as in the speed and degree of the changes and the systems that are affected. There is undoubtedly a significant incidence of androgen defi-ciency in older males when measured by serum levels of bio-available testosterone.

The male climacteric is referred to as andropause, androgen decline in the aging male, late-onset hypogonadism (LOH), or symptomatic LOH. Data from the MMAS suggested that each year, biochemical LOH will be present in 481,000 new cases involving US males ages 40 to 69. Similar numbers can be projected for Europe. Although the MMAS was unable to show an association between ED and a decrease in the serum levels of tes-tosterone, a direct correlation was established between ED and a serum deficit in DHEA and its sulfated form, DHEAS. It is possible in a population study to link age and serum testosterone, but the association between low DHEA and increasing age is so strong and predictable that the specific association between DHEA and ED, independent of age, is difficult to demonstrate. However, a recent study pointed to a true finding of lower DHEA in patients with ED compared to controls. A diagnosis of hypogonadism can rarely be established on the basis of history and physical examination alone.

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