Types of disabilities in middle-aged men

What do you know about menopause in men and what factors cause this to occur in them and what factors play a role in the occurrence of this disease.

The natural process of aging in men is accompanied by a series of physical, emotional and cognitive changes. Many of these changes and related symptoms are also observed in cases of androgen deficiency (male sex hormones). Therefore, many of the changes that develop over time in an aging man may be caused by androgen deficiency.

Dr. Ali Hamidi Madani, associate professor and faculty member of the urology department of Gilan University of Medical Sciences, stating that testosterone (male sex hormone) plays an important role in maintaining the health and quality of life of men, stated: Andropause or male menopause is a clinical and biochemical syndrome in Men are getting older, which is associated with declining testosterone, age-related diseases and infirmities, and general health decline.

He added: This incident may lead to a significant decrease in the quality of life and cause complications and effects on the functioning of many organs of the body. The prevalence of this disease in men over 40 years old based on the classic symptoms of the disease and the serum level of testosterone is significant and is expressed as about 5%. Although its prevalence in the general population seems to be higher than this, a large number of sufferers remain undiagnosed and untreated.

Hamidi Madani, pointing out that the pathophysiology of this disease is mixed, said: the age-related decrease in testosterone serum levels is caused by defects in the functioning of the testicles and also the hypothalamus-pituitary axis. Of course, there is considerable variation between people in the age of onset and the speed and intensity of this decline. Currently, the diagnosis of andropause requires the presence of clinical signs and symptoms confirming testosterone deficiency.

He stated its signs and symptoms including decreased energy, lack of motivation and lack of self-confidence, feelings of sadness, decreased concentration and memory impairment, sleep disorders, mild anemia and reduced ability to do things and said: risk factors for Andropause events in elderly men include chronic diseases, type 2 diabetes, thyroid dysfunction, hyperprolactinemia, COPD, rheumatoid arthritis, obesity, metabolic syndrome, stress, and hemochromatosis. Vitamin D deficiency may also play a major role in the pathogenesis of this disease.

Hamidi Madani continued: Although screening for this disease is not recommended in the general population, it is diagnosed in men with clinical disorders such as decreased libido, sexual dysfunction, decreased mood, fatigue and weakness, cognitive impairment, insulin resistance, obesity, metabolic syndrome, and diabetes. Type 2, decrease in body mass and muscle strength, decrease in bone density and osteoporosis, decrease in life expectancy, vitamin D deficiency, and use of glucocorticoids and opioids are recommended.

He stated: The most accepted parameter to prove the existence of andropause is the measurement of total serum testosterone level.

The vice-president and secretary of the Urology Association of Gilan branch, stating that the goal of treatment is to improve the symptoms of the disease and achieve physiological levels of testosterone, said: Testosterone therapy is recommended for men with symptoms of the disease who are susceptible to treatment and who have the classic signs and symptoms of testosterone deficiency.

He added: Different testosterone compounds should be used for testosterone replacement therapy. Currently, there are intramuscular, subcutaneous, transdermal, oral and buccal forms that are safe and effective. Due to the possibility of unwanted side effects during treatment, especially an increase in hematocrit, which requires rapid discontinuation of testosterone replacement therapy, short-acting testosterone compounds are preferable to long-acting types at the start of treatment for affected patients.

This associate professor and faculty member of the Urology Department of Gilan University of Medical Sciences noted: Improvement in disease manifestations should be monitored after treatment. Failure to improve within a reasonable period of time leads to discontinuation of treatment and search for other causes of the patient’s symptoms. It is recommended to evaluate the patient 3, 6 and 12 months after the start of treatment and then annually to determine whether the symptoms of the disease have responded to the treatment and whether the patient has an untreated complication and wishes to continue the treatment or not.

He said: Improvement in the signs and symptoms of andropause or hypogonadism for different organs occurs at different times, for example, the improvement in libido starts within three weeks from the start of testosterone replacement therapy, but it takes up to 6 weeks from the start of treatment for a significant improvement in performance to occur. Sex takes time. Improvement in the bone status also begins after 6 months from the start of treatment and reaches a maximum in 14 to 36 months.

Stating that there is currently no definitive evidence that testosterone replacement therapy increases the risk of benign prostate enlargement or worsening urinary symptoms, he said: On the other hand, there is evidence that testosterone replacement therapy improves urinary symptoms. It becomes mild in hypogonadal men with BPH.

Hamidi Madani added: At the same time, there is no evidence that testosterone replacement therapy causes the transformation of subclinical prostate lesions into clinically obvious prostate cancer. Therefore, there is evidence that testosterone can stimulate growth and aggravate symptoms in men with advanced and metastatic prostate cancer. Therefore, before starting testosterone replacement therapy, the risk of prostate cancer in the patient should be evaluated using prostate examination and serum PSA measurement. After starting testosterone replacement therapy, the patient should be examined in 3, 6, 12 months and then at least annually, and if the risk of prostate cancer in the patient is high for any reason, prostate biopsy under ultrasound guidance is recommended.

He pointed out: Prevention of obesity and metabolic syndrome and maintaining a healthy lifestyle, including sufficient physical and mental activity and consumption of healthy food, may delay or prevent the occurrence of the disease.

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