• Save
Raising Hope for Fading Manhood
Upcoming SlideShare
Loading in...5
×
 

Raising Hope for Fading Manhood

on

  • 13,998 views

Dr Ho Siew Hong lectured to participants of 'Clarifiying Misconceptions' Public Forum

Dr Ho Siew Hong lectured to participants of 'Clarifiying Misconceptions' Public Forum

Statistics

Views

Total Views
13,998
Views on SlideShare
13,993
Embed Views
5

Actions

Likes
3
Downloads
0
Comments
0

1 Embed 5

http://www.slideshare.net 5

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

Raising Hope for Fading Manhood Raising Hope for Fading Manhood Presentation Transcript

  • Raising Hope for Fading Manhood Dr Ho Siew Hong Consultant Urologist S H Ho Urology and Laparoscopy Centre Gleneagles Hospital
  • Fading manhood – Myth or Fact?
    • Aging
    • Females --> Menopause
    • Men-no-pause
    • Gradual process
  • Changes as a man ages
    • Muscle and bone structure
    • Fat distribution
    • Mental – short term memory, concentration, restful sleep
    • Medical problems – hypertension, diabetes, heart diseases, prostate problems
    • Sexual function – erectile dysfunction
  • What is Erectile Dysfunction (ED) ?
    • Consistent or recurrent inability of a man to attain and/or maintain a penile erection sufficient for sexual activity
    • Independent of sexual desire and the ability to have an orgasm and ejaculate
    National Institute of Health, USA
  • Hope for the fading manhood?
    • YES
  • Do I have ED ?
    • Doctor - Family Physician / Specialist
    • Medical and psychological history from patient and partner
    • Sexual history
    • IIEF Questionaire
    • Focused physical examination
  • Current treatment for ED
    • Tablets – PDE 5 inhibitors
    • Testosterone replacement therapy
    • Intracavernosal injection
    • Vacuum device
    • Surgery
  • Oral erectogenic medications
    • Phosphordiesterase inhibitors (PDE5I)
    • Approved for treatment of erectile dysfunction by FDA in 1998
    • Arrived in shores of Singapore in 21 st century
    • 1 st line of treatment for organic ED
    • Levitra, Viagra, Cialis
  • Are they effective?
    • Effective in 80% - 84 %
    • Satisfactory erection for penetration
    • In the presence of sexual stimulation
    • Correct dosing
    • Correct method of administration
    • Less effective in patients with serious diabetes mellitus, hypertension and other long standing medical conditions
  • What are the side-effects?
    • Headache 15%
    • Flushing 3 – 10%
    • N congestion 5 – 10%
    • Indigestion 3 - 10%
    • Visual disturbance (blue vision) 5%
  • Contra-indications
    • All patients taking medications with nitrates
    • Caution: heart problems (ischaemic heart, valve)
    • Cause sudden and severely low blood pressure
  • How to use them effectively and safely?
    • Only use with prescription from a doctor (not a friend !)
    • Regular check-ups with doctor
    • Correct dose, timing and expectation
    • Do not over dose or mix and match (more does not mean better !)
    • Talk to your partner
  • What if PDE5I is not effective?
  • In non-responders to PDE-5 inhibitors, look for co-morbidities
    • Failure rate of 18 – 37% is reported
    • Depending on co-morbidities thereof:
    • Hypogonadism 50%
    • Diabetes mellitus 35%
    • LUTS / BPS 22%
    • Hypertension 23%
    Yassin et al. IJIR Vol. 14, Suppl. 3, 9/2002
  • Testosterone level and aging
  • Function of Testosterone Lower voice Muscle mass Body and facial hair Penile length and width increase Mental – aggressive, active, interest in opposite sex, libido, memory, concentration Acne Prostate enlarges
  • Late Onset Hypogonadism
    • ADAM, PADAM, Andropause
    • ‘ clinical and biochemical syndrome associated with advancing age and characterized by typical symptoms and a deficiency in serum testosterone levels. It may result insignificant detriment in the quality of life and adversely affect the function of multiple organ systems ’
    • ISA, ISSAM, and EAU recommendations
    • SUA recommendations
  • Clinical manifestation of LOH
    • The easily recognized features of diminished sexual desire (libido) and erectile quality and frequency, particularly nocturnal erections
    • Changes in mood with concomitant decreases in intellectual activity, cognitive functions, spatial orientation ability, fatigue, depressed mood and irritability
    • Sleep disturbances
    • Decrease in lean body mass with associated diminution in muscle volume and strength
    • Increase in visceral fat
    • Decrease in body hair and skin alterations
    • Decreased bone mineral density resulting in osteopenia, osteoporosis and increased risk of bone fractures
  • Diagnosing Andropause
    • Symptoms
    • Blood tests: Testosterone
    • Tests usually done in the morning
  • Treatment for Andropause
  • Testosterone replacement therapy
    • Tablets – Andriol
    • Injections - 3 weekly - 3 monthly (Nebido)
    • Skin patch, gel
  • Effect of Castration and Androgen Substitution on Trabecular Smooth Muscle and Connective Tissue Content in the Corpus cavernosum Traish A et al. Endocrinol 140(4): 1861-1868 (1999) Control Castrated + Vehicle Castrated + Testosterone
  • Overall Response Rate to Testosterone Treatment for Erectile Dysfunction in Hypogonadal Men: Results of a Meta-Analysis Jain P et al. J Urol 164: 371-375 (2000) 203 (57.02 %) 356 Total 14 (100 %) 14 Conway 1988 12 (100 %) 12 Skakkebaek 1981 22 (75.86 %) 29 Arver 1996 10 (43.48 %) 23 Morales 1997 3 (50 %) 6 Kwan 1983 5 (100 %) 5 Ahmed 1988 3 (75 %) 4 Carey 1988 6 (100 %) 6 Davidson 1979 6 (42.86 %) 14 Carani 1990 5 (38.46 %) 13 Benkert 1979 10 (100 %) 10 Nankin 1986 4 (100 %) 4 McClure 1991 10 (83.33 %) 12 Jacobs 1982 21 (95.45 %) 22 Spark 1980 12 (66.67 %) 18 Ou 1991 60 (36.59 %) 164 Baskin 1989
    • Testosterone treatment improves bone mineral density and may reduce the incidence of fractures.
    • Testosterone treatment improves body composition, muscle function, and erythropoiesis.
    • Testosterone treatment improves libido and nocturnal erections.
    • Pilot studies and ongoing clinical studies support the role of testosterone in the management of all components of the metabolic syndrome and its associated diseases.
    Summary and Conclusions
  • Monitoring and Safety
    • Monitoring
    • Baseline: DRE, PSA, fasting lipids, Hb and Hct
    • Improvement in symptoms
    • DRE, PSA, Hb and Hct every 3 months for 1 st year,
    • then yearly, fasting lipids yearly
    • Safety
    • no clear relationship between HRT and prostate cancer
    • anecdotal reports linking HRT to prostate cancer
    • Not recommended in patients with or suspected of prostate cancer
  • Take home message
    • There is hope for the fading manhood
    • PDE 5 inhibitor tablets are effective in 80%
    • Recognize condition of low male hormone (testosterone)
    • Testosterone replacement in selected patients is effective
    • Treatment must be discussed, administered and monitored by health care professionals
  • Thank you