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APSSAM Information on Aging Male
Managed and presented by
The Asia Pacific Society for the Study of the Aging Male (APSSAM)
| The
Asia Pacific Society for the Study of the Aging Male (APSSAM)
Editorial Prevalence of hypogonadism in the aging male and male erectile dysfunction in Asia-Pacific countries |
The Asia Pacific
Society for the Study of the Aging Male (APSSAM) Dato
Hui Meng TAN The Asia Pacific Society for Study of the Aging Male was formed at the successful conclusion of the 1st Asian ISSAM Meeting in Kuala Lumpur in March 2001. Its inauguration was the result of the tremendous interest generated from this Asian Meeting and from the two precedent World Congresses on The Aging Male organized by the International Society for the Study of the Aging Male (ISSAM). APSSAM derived its strength from highly acclaimed opinion leaders from 15 Asia-Pacific countries who are established experts in their respective fields and who have special interest in issues relevant to the Aging Male & Men's Health. APSSAM Council Members are already well recognized opinion leaders in Male Sexual Dysfunction, and the majority of them also serve on Erectile Dysfunction (ED) Councils in their respective countries. These ED councils were the results of widespread publicity and rapidly expanding field of ED following the launch of sildenafil. In many countries, ED, Men's Health and Male Aging are recognized to be very closely interrelated issues, and they are well integrated into continuing medical education programmes and public health promotions. Countries in the Asia-Pacific region, occupying one-third of the world's land area and sustaining 58 % of the world population, have very diverse ethnic, cultural and religious origins. Generally, these markedly contrasting people living in equally contrasting climatic condition are aging like the rest of the world population. The experience of the Western world in handling and managing aging population, though generally well tested and established, cannot be fully adopted and rigidly applied to most Asia- Pacific countries. Asian diets, cultural practices, family values, quality of life issues differ greatly from those of the West. Asia-Pacific leaders need to come up with specific programmes, ideas, researches etc. to be incorporated into those basic principles and practices of managing the aging male population which have been fairly well studied by many Western experts. The Mission of APSSAM is to develop Asia-Pacific specific programmes to help improve awareness, understanding and management of problems of Men's Health in general and of the Aging Male in particular, in order to help men age successfully and to enhance the overall health and quality of life of men of all ages. This will be accomplished through the creation and dissemination of educational and training programmes for medical professionals, patients and the public. By so doing, APSSAM will strive to be the 'Reference Centre' and the 'Centre of Excellence' for the management of problems of the Aging Male and Men's Health in the Asia- Pacific region. APSSAM objectives are as follows:-
Inaugural Council of APSSAM for 2001 ~ 2003:
Executive Committee for 2003 ~ 2005:
Editorial Population aging and the aging male K. K. Chew There is no mystique in the phenomenon of population aging. The challenge really is to fully appreciate its immense and far-reaching impact and consequences. Advances in various biotechnological fields and improvement in environment and healthcare have contributed to a significant decline in mortality rates of diseases. Effective options in fertility control have made it possible for couples to delay starting, and to limit the size of, their families, often in order to give or preserve quality in parenting within their means. Increasing opportunities in the workforce for women and the preference of many for career-orientated lifestyles have brought about changes in family structure and values. Inevitably, increasing life expectancy and declining fertility lead to population aging. Not unexpectedly, an aging population will increase the demand on social, healthcare and support services, causing public as well as private expenditure to escalate. Having a greater proportion of aged persons relative to the working-age population will mean a higher dependency ratio, decreased labour supply and a reduced tax base. These will compound the strain on community resources and make a nations budgetary capacity ultimately untenable. Aging may be associated with a gamut of chronic illnesses, degenerative diseases and debilitating disabilities. In the aging male, gender-specific medical problems are prevalent and significant. These include prostatic diseases, androgen deficiency, erectile dysfunction and other forms of sexual dysfunction. There may also be gender-related increased vulnerability in various clinical and non-clinical conditions. Ironically, the rate of population aging is gaining even greater acceleration in countries and regions where resources are less and ability to cope is lower. In the most socio-economically-disadvantaged groups, both the life expectancy and healthy life expectancy are lowest while the difference between these indicators, denoting the period of burden of disease and disability, remains the greatest. Population projections suggest that, by 2025, Indonesia will have a 414 % increase in her population aged 65 years and older. Likewise, Thailand, India, China and Bangladesh will experience an increase in excess of 200 %. There is therefore an urgent need for appropriate action by specific interest groups and peak organizations such as the Asia Pacific Society for the Study of the Aging Male (APSSAM). As shown in the two reports in this Section, APSSAM was formed in 2001 and has already hosted two successful conferences on The Aging Male, catering especially to the needs of the Asia-Pacific region. With the generous provision of these pages in the Asian Journal of Andrology and with the blessing of a harmonious and genial relationship with the Asian Society of Andrology (both considerations being gratefully acknowledged by APSSAM), it is hoped that the mission and objectives of APSSAM may be more easily achieved. Prevalence of hypogonadism in the aging male and male erectile dysfunction in Asia-Pacific countries K. K. Chew 1 Background Hypogonadism in aging men and male sexual dysfunction are important gender-specific conditions which have significant clinical, epidemiological and socio-economic implications. Data on their respective prevalence are scarce and sporadic. Yet, it is important that such information be available, in order that healthcare planners and providers may allocate appropriate resources for their management and prevention. A Symposium was therefore planned for the 2nd Meeting on The Aging Male organized by the Asia Pacific Society for the Study of the Aging Male (APSSAM) in Taipei on 6th~9th March 2003, so that members of APSSAM would have the opportunity of presenting the relevant data pertinent to their respective countries. The following APSSAM members (in alphabetical order) participated in the Symposium: Prof. A Adimoelja (Surabaya), Dr. KK Chew (Perth), Prof. NP Gupta (New Delhi), Prof. ST Huang (Taipei), Prof. YC Kim (Kyonggi-do), Prof. A Kongkanand (Bangkok), Prof. PHC Lim (Singapore), Prof. A Okuyama (Osaka), Prof. Dato HM Tan (Subang Jaya). This report contains a summary of the data from these presentations, the abstracts of which were published in the Abstract Book of the Meeting. To complement these, data on the subjects that had previously been presented at conferences or published in the medical literature are also included in this report. 2 Prevalence of Hypogonadism in the Aging Male The diagnosis of hypogonadism should only be sustained when biochemically confirmed decreased plasma testosterone (T) levels are clinically collaborated with the appropriate symptom-complex. Most of the data presented therefore referred more to decreased androgen, or, more specifically, decreased T status, suggesting androgen or T deficiency. These data and the
legends used are as follows: T levels on blood samples obtained in a community-based study (n = 927) in Busselton, Australia, were reported [1]. These are shown in Table 1. Table 1. Testosterone levels in aging males: community-based Busselton Study (n = 927)[2].
The results of another Australian study [2] were alluded to which found that 5.7 % of men (n=1,455) with erectile dysfunction had decreased plasma T levels (<11 nmol/L). No prevalence data were presented for India, Indonesia, Japan and Singapore. In Korea, an average of 8.3 % (2.1 % to 21 %) of men (n= 2,722) referred for erectile dysfunction in 7 studies had plasma T levels less than 10.4 nmol/L (300 ng/dL). In a study in Malaysia, plasma T levels of less than 8 nmol/L were found in 40.7 % of men (n= 118) aged 50 years~93 years with general urological problems. St. Louis University ADAM Questionnaire Score was positive in 48.3 %. 3.1 % to 9.8 % of men in Taiwan region with erectile dysfunction had hypogonadism. In Thailand, decreased plasma T levels were reported in 7 % of men aged <60 years and in 70 % of those aged >60 years with sexual dysfunction, Decreased bT was found in up to 70 % of men aged >60 years. 3 Prevalence of male erectile dysfunction In a study on the prevalence of erectile dysfunction (ED) in Australia involving 1,240 attendees at general medical practices [3], the findings reported are shown in Table 2. Table 2. Prevalence of ED: 1240 attendees at general medical practices (Chew et al. [4])
Prevalence and severity of ED increase with age. Prevalence and severity of ED increase with age. No prevalence data were presented for India, Indonesia, Japan, Korea and Malaysia. A survey of 336 patients with sexual dysfunction in Surabaya, Indonesia, showed that 86.3 % had ED and 13.7 % had premature ejaculation. Preliminary findings in a study in Singapore were presented which showed that in men aged 45 years~70 years prevalence of ED was 72.7 % with 14.1 % reporting complete ED. Prevalence of ED in men aged >40 years is 17.7 % in Taiwan area . In Thailand, the findings of a study on the prevalence of ED are shown in Table 3. Table 3. Prevalence of ED in Thailand.
Data on prevalence of ED which had previously been presented at conferences or published in medical literature are shown in Table 4. Table 4. Data presented at previous conferences or published in journals:
References [1] Beilin J, Chew
G, Feddema P, OLeary P. Testosterone levels in aging males: a
population-based study utilizing measurement of total and calculated
bioavailable testosterone. Abstract Book, Annual Meeting &
Clinical Laboratory Expo. 54th Annual Meeting 2001 of American
Association of Clinical Chemistry. The 2nd APSSAM Meeting
on the Aging Male Han Sun CHIANG The Second Meeting of the Asia Pacific Society for the Study of the Aging Male (APSSAM) was held in Taipei from 6 March to 9 March 2003. A total of 432 delegates from 20 countries attended the Meeting. The scientific program included workshops, plenary lectures, panel discussions, symposia as well as oral and poster presentations of free papers. There were also three satellite symposia sponsored by Pfizer, Eli Lilly and Bayer to present and discuss the recent advances in the use of orally effective medications for the treatment of male erectile dysfunction. Topics discussed at the Meeting cover many fields related to problems in the aging male. There has been a significant progress in the research of male climacterics, hormone replacement therapy, osteoporosis, epidemiology and clinical management of prostate cancer in Asia, obesity, diabetes, neurological and psychiatric disorders, sexually transmitted diseases, erectile dysfunction, voiding dysfunction and molecular biology of the aging process. The conference would have succeeded in adding knowledge and updating information concerning the Aging Male in the Asia-Pacific region, as well as advancing expertise in the management of the aging male patients in clinical practice. The Meeting also provided a good opportunity for the members of APSSAM to be together to discuss the very important issue of establishing in their respective countries a national policy dealing with problems of aging population. Issues concerning the quality of life and social life of the Aging Male in the Asian societies were widely discussed. Most of the members reported the prevalence of male hypogonadism and erectile dysfunction of their countries, Further studies in these areas will undoubtedly lead to a better understanding of the Aging Male in the Asia-Pacific region. APSSAM is keen to conduct an investigation which may provide consensus guidelines for the diagnosis and management of male hypogonadism. As Chairman of the Organising Committee, I would like to express my personal appreciation for the kind help from members of APSSAM, especially from the former President, Dr HM Tan, who gave me so many suggestions about the conference from his own experience. I also wish to thank all of the delegates for their attendance at the Meeting. I hope we can work together even more concretely in the future for the further advancement in the study of the Aging Male in Asia-Pacific countries. |
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Editor-in-Chief: Kew-Kim Chew (Perth)
Committee:
Han-Sun Chiang (Taipei)
Narmada Gupta (New Delhi)
Young
Chan Kim (Kyonggi-do)
Sudhakar Krishnamurti (Hyderabad)
Clarence
Chang-Moh Lei (Kuching) Peter Huat-Chye Lim (Singapore)
Hui-Meng Tan (Subang Jaya)
