OBGYN.net Conference CoverageFrom First Congress on Controversies in Obstetrics, Gynecology & Infertility Prague CZECH REPUBLIC - October, 1999
Dr. Mark Perloe: "One of the confusing things that we see headlines on is male menopause and the cause. I'm confused about what I ought to be calling it, and what really is going on with males as they age. Do we need to be concerned about this?"
Professor Bruno Lunenfeld: "Yes, I think so because I think it's quite clear today that there is no male menopause. Males don't have menstruation - there is no stopping of menstruation - and I'm very surprised why even the term "male menopause" came up. To me there's nothing clinical, I just think it's the wrong term. I also think andropause is really responsible for creating this term which is wrong, because it's not only the androgens which go down, we know it's dehydroepiandrosterone sulfate, the adrenal androgen that goes down. We know that hormone secretion, melatonin secretion, and estrogen secretion goes down. So I think with what we actually have is a partial endocrine deficiency syndrome of the aging male, which I would call "PEDAM" - partial endocrine deficiency of aging male. This I think would be the correct scientific name. Today people like to call it, "PADAM" - partial androgen deficiency or andropause because actually the only product on the market today are testosterones. We know very little about dehydroepiandrosterone although I'm quite sure it is very important. We know very little on the condition of cortisol, which we know is very important on this whole effect and bad on muscle composition on osteoporosis. We know very little about melatonin. We know that all the medicines used today in food additives are used less because the half life is very, very short. We need well-standardized melatonin, which can remain eight hours and really simulate the physiological effects to get a good sleep. Because we know that under melatonin we have this slow wave sleep, which is a sound sleep, and during that sound sleep we get secretion of cortisol hormone. So I think a good sleep with secretion of cortisol hormone could be the solution but for the time being there is no standardized melatonin available. Cortisol is expensive but I think in many countries it is forbidden for athletes which is a mistake - so many studies have to be done in order to prove this. Now why do many countries like the word hypogonadism in their aging male because all these products - the testosterone products - are set for hypogonadism so if you go back to the word hypogonadism in the aging male, you've less problems in the registration of products which are readily available."
Dr. Mark Perloe: "The other factor is dealing with insurance companies. A normal physiological condition may not be one that they want to cover and coming up with a CPT or ICD-9 code that warrants the condition or diagnoses it. Is this the sort of thing that men are coming to physicians and complaining about or do you see this as a standard part of the physician's evaluation of the male? I mean, with women we have good evidence that we can prevent heart disease, that we can prevent osteoporosis, and we can improve sleep and do a little on hot flashes. A man doesn't have hot flashes to come in that immediately disrupts his life, and we don't have the obvious indication that we are improving health."
Professor Bruno Lunenfeld: "I thank you very much for this question because I think I have the exact answer which you need here. Women go for prevention, they have gynecologists who are their confidant, and they can discuss with him all kinds of things. They are geared for prevention, they go to the ob-gyn when they are healthy and when they are pregnant. They are geared for prevention, when they have a child, they immunize the child - they will try to keep it well. They will maintain health. Men only go for operations. They don't have a physician, and they don't have men's health physicians. We have to go to the urologist, and we have to teach the urologist - don't put your finger in only like this for the prostate, also put the finger in straight to look for colorectal cancer. So I think we have to teach awareness to men that they should go also for prevention. We know that in Western Europe, nearly 20% of women have a clinical breast examination, self-examination, or mammography - but something - to check for breast cancer. Only 0.3% of men make a PSA - a prostate specific antigen - examination which we can predict cancer expression five years before. So why shouldn't men from fifty onwards have at least one digital examination a year together with a PSA - this would prevent things. So I think here we need to create awareness, and we need to create a men's health physician, and this exam and the International Society of the Study of the Aging Male are really doing this. I very much hope you would come to Geneva, and you will see how much data exists already but it's spread all around. I think Geneva in February 2000, the 9th through the 13th, may be one place where the gap will start closing itself, and you will be able to see a little bit clearer picture."
Dr. Mark Perloe: "Thank you."