3
ESSM
Today
Men’s Health Issue
Men’s health issue represents a crucial topic
of ESSM Congresses. Numerous high quality
studies have submitted and presented at the
16
th
ESSM Congress in Istanbul.
According to current guidelines patients with
obesity and/or type 2 diabetes (T2DM) represent
a population at risk for male hypogonadism. Ac-
cordingly, it has been reported that testosterone
replacement therapy (TRT) in these subjects
might improve glycometabolic control and fat
mass. In line with these data, Aversa et al.,
(PS-02-002) in a 54-weeks prospective con-
trolled study showed that TRT is able to im-
prove body composition and cardio-metabolic
outcomes in a series of 24 severely obese men
(mean BMI 42 kg/m
2
). Similar results were re-
ported by Saad et al., (PS-02-003) in accumula-
tive observational registry study involving 561
T2DM hypogonadal men from two urological
centres followed up to six years and by Zitzman
et al., (PS-02-004) in an other register survey
on 381 hypogonadal receiving testosterone
undecanoate up to 16 years.
The data reported by Shortridge et al., (PS-02-
001) empathized the concept that in the routine
clinical practice the screening for hypogonadism in
the diabetic population remains poor if not ignored.
Where or not TRT might represent a new therapy
for T2DM has not be completely clarified and
must be confirmed in further longer double-blain
placebo controlled studies. Recent meta-anal-
ysis (HP-10-005) documented that weight loss
whatever obtained is able to improve testosterone
levels in hypogonadal men. Hence, according to
current guidelines weight loss and lifestyle modi-
fications should be considered the first approach
to overweight or obese hypogonadal men.
Scientific Highlights from Istanbul:
Men’s Health, Women’s Health
by Giovanni Corona
dr. giovanni corona
Endocrinology Unit
Maggiore-Bellaria Hospital
Bologna, Italy
Several reports have even documented that low
T might increase the risk of overall and cardio-
vascular (CV) mortality in men. The link between
reduced T levels, T2DM and obesity can explain,
at least partially, these data. Interestingly, recent
data have suggested that not only low T but also
elevated LH could represent independent risk
factor for mortality in men. Accordingly Rastrelli
et al., (HP-07-003), in a series of 2,809 men
with ED showed that elevated LH represented
an independent marker of CV risk.
Obesity has been previously associated with
decreased levels of circulating prolactin (PRL)
and with impaired PRL responsiveness to sev-
eral pharmacological stimuli, including insulin-
induced hypoglycaemia and TRH. In line with
these data, Corona et al., (PS-02-005) in the
cross-sectional analysis of the European Male
Ageing Study, a prospective, observational cohort
of community dwelling men aged 40-79 years,
report that PRL is negatively associated with an
unhealthy metabolic phenotype as well as with
the metabolic syndrome.
The relationship between erectile dysfunction
(ED) and increased CV risk is well documented.
However, the knowledge of this link among
health care professionals remains poor. Kalka
et al., (PS-08-005) reported data on 412 pa-
tients evaluated during cardiac rehabilitation
after myocardial infarction. Only 8.89% of all
participants had an interview about ED and in
only 2.18% of cases ED had been diagnosed
earlier and was treated.
Phosphodiesterase type 5 inhibitors (PDE5i) rep-
resent the first line therapy for patients with ED.
However, the dropt-out rate remains quite high.
Tadalafil one daily (OaD) is a well documented
safe and effective treatment for ED subjects.
Buvat et al., (PS-08-008) reported that data on
EDATE study evaluating time to switch or dis-
continuation from ED-treatment with Tadalafil
5 mg OaD. They reported that under routine con-
ditions, more than 68% of men starting/switching
Tadalafil OaD continued treatment more than
6 months. In another elegant double-blind pla-
cebo controlled study Patel et al., (PS-07-003)
documented positive effects of tadalafil OaD on
erectile function recovery in patients who under-
went radical prostatectomy for clinically localized
prostate cancer. Similar results were reported by
Moncada et al., (HP-06-002) in 203 patients
treated with robotic prostatectomy.
Vardenafil orodispersible (ODT) represent a quite
recent new formulation of Vardenafil which sig-
nificantly improves erectile function in men with
ED regardless of age, baseline severity, or un-
derlying conditions. Salonia et al., (PS-08-010)
in one of the first pot-marketing study, evaluated
the impact of Vardenafil ODT on 100 subjects
with ED. They found that one out of three ED
patients taking Vardenafil ODT reports a satisfac-
tory erection less than 30 mitues fater the drug
intake in the real life setting.
Much evidence has already confirmed that Low
Intensity Shock Wave therapy (LI-ESWT) should
represent a further treatment option in patients
with ED. In a long term efficacy (up to 2 years)
study Vardi et al., (PS-08-013) showed that more
than 50% of patients treated with this approach
maintained their initial success.
Penile implant surgery the last option in unre-
sponsive ED subjects. Pereira et al., (HP-02-003)
presented the frequency data on 202 patients
with severe ED who underwent penile implan-
tation between 1993 and 2012. The overall
satisfaction rate was 75% and complications
which required surgical management occurred
in 7% of subjects.
Peyronie ‘s disease (PD) represent a rare clini-
cal condition which pathogenesis remains poor
understood. Salonia et al., (PS-09-001), reported
that PD was diagnosed in 13% of patients with
1140 patients seeking medical care for sexual
dysfunction. Autoimmune diseases remerged as
a common associated morbidities in subjects
with PD being present in 9.5% of cases. The
medical treatment of PD is essentially based
on intralesional verapamil and oral antioxidants.
Privitera et al., (PS-09-003) documented a pos-
