Erectile Dysfunction & Hypo Androgen-Metabolic Syndrome (ED and HAM)

Presentation

On presentation for erectile dysfunction to a Urologist may lead to a concommontent diagnosis of the Hypo Androgen-Metobolic Syndrome (HAM Syndrome).

What is it?

In order for a man to obtain an ade-quate erection it requires more blood to be in the penis at any one moment than is flowing out over that period of time in order for the erection to hold. A large number of factors are associated with the ability to get an erec-tion, including desire (libido), and good cir-culation. These things can be adversely af-fected by such conditions as smoking, high blood pressure, high cholesterol, obesity, Diabetes and neurological (nerve) disor-ders. Surgery or medical conditions in the lower bowel or pelvic region may be a factor also.

The diagnosis for the metabolic-syndrome requires any three of the following:-

  • Waist circumference from 88cm
  • BP greater than or equal to 130mm hg sys-tolic or 85mm hg diastolic or on hyperten-sive medication.
  • HDL-C less than 0.9mmol/L or drug treatment to reduce HDL-C
  • Fasting Tryclicerides great than or equal to 1.7mmol/L or drug treatment for elevated Tryclicerides
  • Fasting Glucose greater than or equal to 5.6mmol/L or drug treatment for elevated Glucose.

That is from the American Heart Associa-tion/National Heart Lung and Blood Scien-tific statement 2005.

Erectile dysfunction is common in over weight men and may be associated with low serum Testosterone (male hormone) levels. As men get older male hormone levels de-crease and after the age of 30, may decrease by 1-2% per year. This is a very gradual de-cline, unlike female hormones which de-crease significantly more rapidly at the time of menopause. Approximately 10% of men aged 40-60 and 30% of men aged 60-80 have decreased hormone levels.

It is not certain whether the decrease in hor-mone levels leads to the increase in weight, but it is thought that the increase in weight will lead to more symptoms of a decreased hormone level and the hormone level to de-crease further, as it may be absorbed into the fat cells of the body and therefore be less ef-fective for other usage.

With the obesity academic occurring in a number of countries including Australia, it is possible that almost half the men over the age of 50 have the metabolic syndrome.

What symptoms are likely to develop with low Testosterone?

Psychological symptoms:

  • Tiredness
  • Depressed mood
  • Irritability
  • Poor concentration
  • Reduced short term memory

Physical symptoms:

  • Weakness
  • Muscle and join pains
  • Sweating and hot flushes
  • Dryness of skin
  • Reduced muscle mass and strength
  • Increased abdominal gurth and obsecity
  • Breast enlargement
  • Reduced body and facial hair

Sexual:

  • Reduced libido (desire)
  • Erectile dysfunction (impotence)
  • Disturbance of ejaculation (may be prema-ture or failure)

Low Hormone Levels

Males who be associated with male osteopo-rosis (thinning of bones).

What Can Be Done

Generally speaking, the assistance of a dieti-tian and a regular exercise program may be the most likely to succeed in conjunction with the practitioner who is best place to look after the mans general health and be able to judge his ability to exercise and carry out a diet.

However a lot of patients prefer to “do it themselves”.

Generally speaking, diet such as those advo-cated by the CSIRO ann such commercial publications as Mens Health may well be the simplest and easiest approach.

In some cases obesity is so significant the man may be advised to seek further advise regarding the possibility of lap banding.

From the point of view of exercise, generally speaking, a 40 minute period of excise 3 days per week of walking/running, bike rid-ing or swimming along with 2 days per week of 20-40 minute of resistance exercises (lift-ing light weights) along with the dietary measures is likely in the long term to provide some degree of weight loss. Please note that is is essential that the man has a medical check up with his general practitioner prior to contemplating changes in levels of his physical activity.

Hormone Replacement

In some men it is necessary to provide hor-mone replacement and that may be carried out through oral (tablets) medication which is easily personalized to the correct level be-cause of the ease of variability in dosage, patches with allow hormone absorption through the skin, gels which are similar to the patches, injections which may last for 12-14 weeks, therefore not needing regular in-gestion. A need for less supplementation will be determined by the doctor.