- Email: [email protected]
Phlebological aspects of the testosterone replacement therapy of the late onset hypogonadism
WCMH Abstracts 182
184
ENGAGING VULNERABLE MEN IN IRELAND
MEN’S HEALTH AND SPORTING VENUES
Paula Carroll
A. White ∗ , K. Witty
Centre for Health Behaviour Research, Waterford Institute of Technology, Ireland E-mail address: [email protected].
Centre for Men’s Health, Leeds Metropolitan University, England E-mail address: [email protected] (A. White).
The health status of men is closely linked to economic opportunity in society; a clear gradient in health has been demonstrated with those in the lowest socio-economic group (SEG) carrying a disproportionate burden of ill health, mortality [1,2] and premature death [2]. Quality of life and perception of general health are also SEG dependant with those in the higher SEGs reporting a better quality of life and general health [3]. In recent years, Ireland has experienced considerable social change. Following an unprecedented economic boom in the 1990s, during which time the economic disparity between the rich and poor increased [4], Ireland is now experiencing a recession. With the downturn in the economy, labour market vulnerability and lack of security of job tenure are increasingly associated with poverty and social exclusion, and are issues that are now beginning to have a much greater bearing on men’s health than before [5]. Many men are experiencing marginalization due to such social and economic change as well as unemployment, poor education, poverty and/or poor living conditions. The reintegration of these men into community and social networks is essential in terms of improving their health. By empowering these men to take control of their lives, they may ultimately be able to change the circumstances that contribute to their marginalisation. In keeping with existing government policy, Ireland’s National Men’s Health Policy [6] has prioritised the needs of the most vulnerable and marginalised men in society for targeted action. The ten key principles for effectively engaging with men will continue to guide the work done with this group. These include the following; 1) adopt a positive approach to men’s health work, 2) create non-threatening and male-friendly environments, 3) make services and programmes easily accessible, 4) use language that is positive and solution-focused, 5) initial contact and marketing, 6) consult and involve men in programme development and programme delivery, 7) find a ‘hook’, and look for a way in that will appeal to men, 8) adopt a ‘hands-on approach and make sure there is a clear focus to the work, 9) plan small and realistically, 10) strive for higher standards of best practice in the future [7—10]. Currently, the nature of community work currently being done with men in Ireland is quite varied and there is evidence that men are willing participants in both task orientated [11] and personal development work [12]. There is also evidence that men need to be targeted exclusively and that the nature of the work may differ considerably to that preferred by women. Notably, by addressing health inequalities among men in Ireland, women, children and society as a whole will experience both direct and indirect benefits [13].
The publication of the Ottawa Charter in 1986 and the assertion that ‘health is created and lived by people within the settings of their everyday life; where they learn, work, play and love’ provided impetus for the development of a settings based approach within the field of health promotion. Within Men’s Health, workplaces, schools and prisons have been successfully used as settings for service delivery. Sports clubs, and the sporting venues which they are resident, often provide hubs for community engagement and have been used in the past to stimulate urban and economic regeneration. In recent years those working within men’s health have paid greater attention to the potential role of sporting venues in regeneration of a different kind, the regeneration of male health. Drawing on examples of good practice a critical discussion will be formed on the use sporting settings for delivery of health promotion interventions. Attention will be paid to the research and development opportunities raised by recent policy and forthcoming sporting events such as the 2012 Olympic games. Concern will be expressed over the apparent disparity between the innovative work currently being conducted within sporting venues and the limited research based evidence being disseminated. doi:10.1016/j.jomh.2009.08.181
References [1] Balanda, K.P. and J. Wilde, Inequalities in Mortality — A Report on All-Ireland Mortality Data. Dublin: The Institute of Public Health in Ireland, 2001. [2] O’Shea E. Male mortality differentials by socio-economic group in Ireland. Social Science and Medicine 1997;45(6):803—9. [3] Balanda KP, Wilde J. Inequalities in Perceived Health Dublin. The Institute of Public Health in Ireland; 2003. [4] Reynolds B. Mind the Gap between Rich and Poor. Belfast: Northern Ireland Council for Voluntary Action; 2005. Available at http://www.nivca.org. [5] Richardson N, Carroll P. Getting Men’s Health onto a Policy Agenda — Charting the Development of a National Men’s Health Policy in Ireland. Journal of Men’s Health 2009;6(2):105—13. [6] Department of Health and Children. National Men’s Health Policy 2008-2013. Working with men in Ireland to achieve optimum health and wellbeing. Prepared by; Richardson N, Carroll P. Dublin: Department of Health and Children; 2008. [7] Robertson S. Men managing health. Men’s Health Journal 2003;2(4):111—3. [8] Fowler, C., ‘‘The Engagement Jigsaw’’: A 12 Point Plan for Effectively Engaging with Men. Available at http://www.mensproject.org/issues/engagement.pdf, 2004. [9] King, A., Engaging fathers in group work. Developing Practice. Available at http://menshealth.uws.edu.au/documents/, 2001. [10] King A, Sweeney S, Fletcher R. A checklist for organizations working with fathers using the nondeficit approach. Children Australia 2005;30(3):1—8. [11] A study of the situation of single rural men. Leitrim: North Leitrim’s Men’s Group, 2001. [12] Men’s Development Network. Waterford: Caterine St. Available at www.mens-network.net. [13] Bonhomme J. Men’s health: impact on women, children and society. Journal of Men’s Health 2007;4(2):124—30. doi:10.1016/j.jomh.2009.08.179
185 PHLEBOLOGICAL ASPECTS OF THE TESTOSTERONE REPLACEMENT THERAPY OF THE LATE ONSET HYPOGONADISM A. Tsukanov 1,∗ , V. Lavrishin 2
183 ESTIMATION OF LEIDIG CELL POPULATION UNDER EXPERIMENTAL THERAPY BY FORTIFIED CELL CULTURE IN ABDOMINAL CRYPTORCHIDISM A. Kamalov 1 , D. Ohobotov 1,∗ , Y. Kudryavtsev 1 , V. Kirpatovsky 1 , E. Efremov 1 , G. Sukhih 2 , R. Poltavtseva 2 , E. Plotnikov 2 , E. Zaraisky 3 1 Institute of Urology, Moscow, Russia, 2 V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Federal Agency of Medical Technologies, Moscow, Russia, 3 Institute of Applied Mechanics, Scientific Academy of Russia, Moscow, Russia E-mail address: [email protected] (D. Ohobotov). Background: Research question. Methods: We are presenting the Leidig cell’ population changes in white rats with induced abdominal cryptochidism, under experimental intratesticular xenotherapy by cultures, fortified by human stem and progenitore cells of different kinds. Were used the fortified cultures of stem and progenitore cells of the human fetal bone’s brain and fetal testicle. Control group beard an intratesticular injection of isotonic sodium solution. Microscopic estimation of the Leidig cell’ state done on 14th and 28th days after xenotransplantation, by it’s counting in 30 intrachanelled locuses, with the simultaneous morphometric estimation.
1 Omsk State Medical Academy, Omsk, Russia, 2 Regional Center of Andrology, Omsk, Russia E-mail address: [email protected] (A. Tsukanov).
Background: Late onset hypogonadism (LOH) affects up to one third of elderly men. The main treatment strategy is testosterone replacement therapy now. Generally known that molecular structure of the estrogens and the androgens is similar. Besides, most physiological effects both of them just the same. Negative phlebological effect’s is postulated. This trial was performed to study influence of the testosterone replacement therapy in men with late onset hypogonadism on the vein wall. Methods: A total of 78 men with LOH with a mean age of 49.6yrs (range: 42-63yrs) entered the analysis. There is no previous history of any varicosity. Mean value (±SD) of total testosterone was 8.5 ± 3.1, free testosterone — 16.4 ± 4.6, sex-hormone binding globulin — 39.8 ± 18.5, Heinemann’s Aging Males’ Symptoms rating scale (AMS) 36.5 ± 6.8. Diameter of the left common femoral vein (CFV) and left long saphenous vein (LSV) was measuring in vertical patient position with usual breathing and with Valsalva maneuver. This kind of measuring took place before and 2 month since start of testosterone replacement therapy (TRT). All measuring was done in the evening, in the same time, after usual activity. Testosterone undecanoate or transdermal form of testosterone was administrated to all patients.
Results: In time of examination of the Leidig cell state in animal, were found, that in case of 3 week abdominal cryptorchidism, increasing the cell quantity in the locus’s between seminal channelets, from the count on 1 channelet, also were detected the nuclei hyperchromy and increasing of the chromaphyne granules. After 2 weeks after bringing down the testicles into the scrotum, in the main groups were found decreasing of the Leidig cells with hyperchromic nuclei from the count of 1 chennelet. That cells characterized by normochrome coloration of the nuclei and less quantity of the chromaphyne granules. In the group were marked increasing of the Leidig cells with hyperchromic nuclei quantity and increasing quantity of the chromaphyne granules. To 28 day of investigation there found decreasing the Leidig cell’s quantity, characterized by nuclei normochromy and moderate quantity of chomaphynnic seeds. In the control group were found further escalation of the Leidic cell’ quantity, with the decreasing of the nuclei’ chromity and decreasing of the chromaphynnic seeds quantity.
Results: The diameter of CFV before starting TRT was 1.3sm (std. err. of mean ±0.12), LSV was 0.83sm (std. err. of mean ±0.04), growth of diameter’s during Valsalva maneuver was 0.12sm (std. err. of mean ±0.01) and 0.05sm (std. err. of mean ±0.01) accordingly. There is no any sing of venous reflux in saphenofemoral junction. After 2 month of TRT the results was following. The diameter of CFV after starting therapy was 1.6sm (std. err. of mean ±0.1, p<0.05), LSV was 1.02sm (std. err. of mean ±0.04, p<0.055), growth of diameter’s during Valsalva maneuver was 0.17sm (std. err. of mean ±0.02, p<0.05) and 0.09sm (std. err. of mean ±0.01, p<0.06) accordingly. Beside, in 19 cases (24.4%) venous reflux in saphenofemoral junction during Valsalva maneuver and in 13 cases (16.7%) the chronic venous insufficiency grade 1 by CEAP was found.
Conclusion: There were regeneration of the common Testosterone level and Gonadotropin level till normal in the all groups after abdominal cryptorchidism liquidation. But in estimation of the Leidig cell’ were found, that in the control group that achieved for the account of quantitative increasing of population, and under experimental cell’ therapy - for account of qualitative compound.
Conclusions: According to our data, the testosterone replacement therapy of the LOH produce negative phlebological influence and can lead to manifestation of varicose disease.
doi:10.1016/j.jomh.2009.08.180
doi:10.1016/j.jomh.2009.08.182
jmh
Vol. 6, No. 3, pp. 229–275, September 2009
273
184
ENGAGING VULNERABLE MEN IN IRELAND
MEN’S HEALTH AND SPORTING VENUES
Paula Carroll
A. White ∗ , K. Witty
Centre for Health Behaviour Research, Waterford Institute of Technology, Ireland E-mail address: [email protected].
Centre for Men’s Health, Leeds Metropolitan University, England E-mail address: [email protected] (A. White).
The health status of men is closely linked to economic opportunity in society; a clear gradient in health has been demonstrated with those in the lowest socio-economic group (SEG) carrying a disproportionate burden of ill health, mortality [1,2] and premature death [2]. Quality of life and perception of general health are also SEG dependant with those in the higher SEGs reporting a better quality of life and general health [3]. In recent years, Ireland has experienced considerable social change. Following an unprecedented economic boom in the 1990s, during which time the economic disparity between the rich and poor increased [4], Ireland is now experiencing a recession. With the downturn in the economy, labour market vulnerability and lack of security of job tenure are increasingly associated with poverty and social exclusion, and are issues that are now beginning to have a much greater bearing on men’s health than before [5]. Many men are experiencing marginalization due to such social and economic change as well as unemployment, poor education, poverty and/or poor living conditions. The reintegration of these men into community and social networks is essential in terms of improving their health. By empowering these men to take control of their lives, they may ultimately be able to change the circumstances that contribute to their marginalisation. In keeping with existing government policy, Ireland’s National Men’s Health Policy [6] has prioritised the needs of the most vulnerable and marginalised men in society for targeted action. The ten key principles for effectively engaging with men will continue to guide the work done with this group. These include the following; 1) adopt a positive approach to men’s health work, 2) create non-threatening and male-friendly environments, 3) make services and programmes easily accessible, 4) use language that is positive and solution-focused, 5) initial contact and marketing, 6) consult and involve men in programme development and programme delivery, 7) find a ‘hook’, and look for a way in that will appeal to men, 8) adopt a ‘hands-on approach and make sure there is a clear focus to the work, 9) plan small and realistically, 10) strive for higher standards of best practice in the future [7—10]. Currently, the nature of community work currently being done with men in Ireland is quite varied and there is evidence that men are willing participants in both task orientated [11] and personal development work [12]. There is also evidence that men need to be targeted exclusively and that the nature of the work may differ considerably to that preferred by women. Notably, by addressing health inequalities among men in Ireland, women, children and society as a whole will experience both direct and indirect benefits [13].
The publication of the Ottawa Charter in 1986 and the assertion that ‘health is created and lived by people within the settings of their everyday life; where they learn, work, play and love’ provided impetus for the development of a settings based approach within the field of health promotion. Within Men’s Health, workplaces, schools and prisons have been successfully used as settings for service delivery. Sports clubs, and the sporting venues which they are resident, often provide hubs for community engagement and have been used in the past to stimulate urban and economic regeneration. In recent years those working within men’s health have paid greater attention to the potential role of sporting venues in regeneration of a different kind, the regeneration of male health. Drawing on examples of good practice a critical discussion will be formed on the use sporting settings for delivery of health promotion interventions. Attention will be paid to the research and development opportunities raised by recent policy and forthcoming sporting events such as the 2012 Olympic games. Concern will be expressed over the apparent disparity between the innovative work currently being conducted within sporting venues and the limited research based evidence being disseminated. doi:10.1016/j.jomh.2009.08.181
References [1] Balanda, K.P. and J. Wilde, Inequalities in Mortality — A Report on All-Ireland Mortality Data. Dublin: The Institute of Public Health in Ireland, 2001. [2] O’Shea E. Male mortality differentials by socio-economic group in Ireland. Social Science and Medicine 1997;45(6):803—9. [3] Balanda KP, Wilde J. Inequalities in Perceived Health Dublin. The Institute of Public Health in Ireland; 2003. [4] Reynolds B. Mind the Gap between Rich and Poor. Belfast: Northern Ireland Council for Voluntary Action; 2005. Available at http://www.nivca.org. [5] Richardson N, Carroll P. Getting Men’s Health onto a Policy Agenda — Charting the Development of a National Men’s Health Policy in Ireland. Journal of Men’s Health 2009;6(2):105—13. [6] Department of Health and Children. National Men’s Health Policy 2008-2013. Working with men in Ireland to achieve optimum health and wellbeing. Prepared by; Richardson N, Carroll P. Dublin: Department of Health and Children; 2008. [7] Robertson S. Men managing health. Men’s Health Journal 2003;2(4):111—3. [8] Fowler, C., ‘‘The Engagement Jigsaw’’: A 12 Point Plan for Effectively Engaging with Men. Available at http://www.mensproject.org/issues/engagement.pdf, 2004. [9] King, A., Engaging fathers in group work. Developing Practice. Available at http://menshealth.uws.edu.au/documents/, 2001. [10] King A, Sweeney S, Fletcher R. A checklist for organizations working with fathers using the nondeficit approach. Children Australia 2005;30(3):1—8. [11] A study of the situation of single rural men. Leitrim: North Leitrim’s Men’s Group, 2001. [12] Men’s Development Network. Waterford: Caterine St. Available at www.mens-network.net. [13] Bonhomme J. Men’s health: impact on women, children and society. Journal of Men’s Health 2007;4(2):124—30. doi:10.1016/j.jomh.2009.08.179
185 PHLEBOLOGICAL ASPECTS OF THE TESTOSTERONE REPLACEMENT THERAPY OF THE LATE ONSET HYPOGONADISM A. Tsukanov 1,∗ , V. Lavrishin 2
183 ESTIMATION OF LEIDIG CELL POPULATION UNDER EXPERIMENTAL THERAPY BY FORTIFIED CELL CULTURE IN ABDOMINAL CRYPTORCHIDISM A. Kamalov 1 , D. Ohobotov 1,∗ , Y. Kudryavtsev 1 , V. Kirpatovsky 1 , E. Efremov 1 , G. Sukhih 2 , R. Poltavtseva 2 , E. Plotnikov 2 , E. Zaraisky 3 1 Institute of Urology, Moscow, Russia, 2 V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Federal Agency of Medical Technologies, Moscow, Russia, 3 Institute of Applied Mechanics, Scientific Academy of Russia, Moscow, Russia E-mail address: [email protected] (D. Ohobotov). Background: Research question. Methods: We are presenting the Leidig cell’ population changes in white rats with induced abdominal cryptochidism, under experimental intratesticular xenotherapy by cultures, fortified by human stem and progenitore cells of different kinds. Were used the fortified cultures of stem and progenitore cells of the human fetal bone’s brain and fetal testicle. Control group beard an intratesticular injection of isotonic sodium solution. Microscopic estimation of the Leidig cell’ state done on 14th and 28th days after xenotransplantation, by it’s counting in 30 intrachanelled locuses, with the simultaneous morphometric estimation.
1 Omsk State Medical Academy, Omsk, Russia, 2 Regional Center of Andrology, Omsk, Russia E-mail address: [email protected] (A. Tsukanov).
Background: Late onset hypogonadism (LOH) affects up to one third of elderly men. The main treatment strategy is testosterone replacement therapy now. Generally known that molecular structure of the estrogens and the androgens is similar. Besides, most physiological effects both of them just the same. Negative phlebological effect’s is postulated. This trial was performed to study influence of the testosterone replacement therapy in men with late onset hypogonadism on the vein wall. Methods: A total of 78 men with LOH with a mean age of 49.6yrs (range: 42-63yrs) entered the analysis. There is no previous history of any varicosity. Mean value (±SD) of total testosterone was 8.5 ± 3.1, free testosterone — 16.4 ± 4.6, sex-hormone binding globulin — 39.8 ± 18.5, Heinemann’s Aging Males’ Symptoms rating scale (AMS) 36.5 ± 6.8. Diameter of the left common femoral vein (CFV) and left long saphenous vein (LSV) was measuring in vertical patient position with usual breathing and with Valsalva maneuver. This kind of measuring took place before and 2 month since start of testosterone replacement therapy (TRT). All measuring was done in the evening, in the same time, after usual activity. Testosterone undecanoate or transdermal form of testosterone was administrated to all patients.
Results: In time of examination of the Leidig cell state in animal, were found, that in case of 3 week abdominal cryptorchidism, increasing the cell quantity in the locus’s between seminal channelets, from the count on 1 channelet, also were detected the nuclei hyperchromy and increasing of the chromaphyne granules. After 2 weeks after bringing down the testicles into the scrotum, in the main groups were found decreasing of the Leidig cells with hyperchromic nuclei from the count of 1 chennelet. That cells characterized by normochrome coloration of the nuclei and less quantity of the chromaphyne granules. In the group were marked increasing of the Leidig cells with hyperchromic nuclei quantity and increasing quantity of the chromaphyne granules. To 28 day of investigation there found decreasing the Leidig cell’s quantity, characterized by nuclei normochromy and moderate quantity of chomaphynnic seeds. In the control group were found further escalation of the Leidic cell’ quantity, with the decreasing of the nuclei’ chromity and decreasing of the chromaphynnic seeds quantity.
Results: The diameter of CFV before starting TRT was 1.3sm (std. err. of mean ±0.12), LSV was 0.83sm (std. err. of mean ±0.04), growth of diameter’s during Valsalva maneuver was 0.12sm (std. err. of mean ±0.01) and 0.05sm (std. err. of mean ±0.01) accordingly. There is no any sing of venous reflux in saphenofemoral junction. After 2 month of TRT the results was following. The diameter of CFV after starting therapy was 1.6sm (std. err. of mean ±0.1, p<0.05), LSV was 1.02sm (std. err. of mean ±0.04, p<0.055), growth of diameter’s during Valsalva maneuver was 0.17sm (std. err. of mean ±0.02, p<0.05) and 0.09sm (std. err. of mean ±0.01, p<0.06) accordingly. Beside, in 19 cases (24.4%) venous reflux in saphenofemoral junction during Valsalva maneuver and in 13 cases (16.7%) the chronic venous insufficiency grade 1 by CEAP was found.
Conclusion: There were regeneration of the common Testosterone level and Gonadotropin level till normal in the all groups after abdominal cryptorchidism liquidation. But in estimation of the Leidig cell’ were found, that in the control group that achieved for the account of quantitative increasing of population, and under experimental cell’ therapy - for account of qualitative compound.
Conclusions: According to our data, the testosterone replacement therapy of the LOH produce negative phlebological influence and can lead to manifestation of varicose disease.
doi:10.1016/j.jomh.2009.08.180
doi:10.1016/j.jomh.2009.08.182
jmh
Vol. 6, No. 3, pp. 229–275, September 2009
273