Friday, February 13, 2015

Men are in better health when testosterone levels are kept up

Men are in better health when testosterone levels are kept up

Maintaining testosterone levels may prevent obesity, loss of muscle mass, depression and lethargy. Photo: Filepic
Maintaining testosterone levels may prevent obesity, loss of muscle mass, depression and lethargy. Photo: Filepic
Low testosterone levels have many consequences, including erectile dysfunction.
Testosterone is a hormone produced in the body. In men, it comes mainly from the testes, but small amounts are also produced by the adrenal glands located just above the kidneys. Levels in men peak during teen and early adult years, but start declining at the rate of about one per cent per year after the age of 30.
When testosterone levels in the body dip to a low level, the body experiences changes like obesity (increased waist circumference), muscle mass loss, lethargy, mood disturbance, irritability, depression, loss of concentration and what men fear most – erectile dysfunction. This is known as Testosterone Deficiency Syndrome or hypogonadism. There is no accurate cut-off point, but the consensus is that this usually occurs when testosterone levels in the body drops below 12 nmol/L.
When men experience these problems and there are documented low testosterone levels, the body would need replacement in the form of synthetic testosterone in the form of capsules taken orally, injections, gels applied to the body or a body spray. Studies show that in men who have low levels of testosterone, when a replacement is given, the quality of life and mood is improved.
There is increased muscle mass and alteration of fat distribution with testosterone therapy. Waist circumference is decreased and obesity reduced. The improvement in weight reduction and maintenance is better when testosterone is added compared to just lifestyle changes such as exercise and diet.
Those who experience erectile dysfunction and have low levels of testosterone normally would not respond optimally with medications such as tadalafil, vardenafil or sildenafil. They would need testosterone replacement to achieve normal levels before these medications can do their job. Studies show that testosterone supplementation can correct high cholesterol levels, obesity, high blood pressure and diabetes mellitus, and improve the overall well-being of men.
Other studies show the benefits of normalising testosterone levels on the heart. It improves myocardial ischaemia and stabilises the heart. It has been demonstrated that low testosterone levels in the body are predictors of increased mortality in men with heart failure. Testosterone replacement is also associated with decreased risk of death and has been shown to be able to reduce mortality by about 50% in men with low testosterone.
Known side effects of testosterone replacement include acne/oily skin, mild fluid retention, stimulation of prostate tissue, with perhaps some increased urination symptoms such as a decreased stream or frequency, breast enlargement, worsening of sleep apnoea (a sleep disorder that results in frequent night time awakenings and daytime sleepiness), decreased testicular size, increase in red blood count and decreased sperm count. It does not however cause prostate cancer.
Lately, the medical world was alarmed by two controversial studies stating that testosterone replacement therapy increases heart attack and stroke risks. Analysis showed they were fraught with discrepancies. The International Society of Sexual Medicine has issued a statement against these studies. Twenty-five medical societies have joined the Androgen Study Group to petition the journal to retract the misleading testosterone study.
Men diagnosed with testosterone deficiency should consider treatment with testosterone therapy after full discussion with their healthcare provider. This provides significant benefits for men with sexual symptoms, and also for a variety of non-sexual symptoms.
Like all medical treatments, testosterone therapy is associated with risks and should be discussed with one’s healthcare provider. Caution should exercised by those with sleep apnoea, congestive heart failure, symptoms consistent with lower urinary tract obstruction, and personal or family history of prostate or breast cancer.
This article is contributed by The Star Health & Ageing Panel, which comprises a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public. The members of the panel include: Datuk Prof Dr Tan Hui Meng, consultant urologist; Dr Yap Piang Kian, consultant endocrinologist; Datuk Dr Azhari Rosman, consultant cardiologist; A/Prof Dr Philip Poi, consultant geriatrician; Dr Hew Fen Lee, consultant endocrinologist; Prof Dr Low Wah Yun, psychologist; Datuk Dr Nor Ashikin Mokhtar, consultant obstetrician and gynaecologist; Dr Lee Moon Keen, consultant neurologist; Dr Ting Hoon Chin, consultant dermatologist; Prof Khoo Ee Ming, primary care physician; Dr Ng Soo Chin, consultant haematologist. For more information, The Star Health & Ageing Advisory Panel provides this information for educational and communication purposes only and it should not be construed as personal medical advice. The Star Health & Ageing Advisory Panel disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article.

Friday, December 26, 2014


A Guide to the Qualification Examination and ESSM Preparation Course

The qualification examination of the Multidisciplinary Joint Committee on Sexual Medicine (MJCSM)

Sexual Medicine is a discipline concerned with the impact of physiology and pathophysiology, psychology and psycho-pathology, relationships, socio-cultural influences, developmental effects, sexual identity, sexual behaviours, gender identity and intergender differences on the sexuality of men and women of all ages, both as individuals and within the context of their relationships.
Its aim is the restoration of sexual health, a state of complete physical, mental, and social well-being with respect to sexuality, as well as the management of sexual problems.
The MJCSM was established by the UEMS specialist sections of Urology, Obstetrics and Gynaecology and Psychiatry and functions within the framework of their respective statutes and bylaws.
The main objective is to guarantee the highest standards of health care in the field of Sexual Medicine in the countries of the European Union and associated European countries, by ensuring that the training in Sexual Medicine is raised to the optimal level. The MJCSM shall recommend the content of training programmes, the access for training, and professional knowledge and skills for Sexual Medicine.
The MJCSM issues a certificate of recognition of quality of the training programme. Prior to entry into training in Sexual Medicine, candidates should be accredited in a medical specialty relevant to the practice of Sexual Medicine. Such specialities include Urology, Obstetrics and Gynaecology, Psychiatry, Internal Medicine and General Practice, although this is not a comprehensive list.
The MJCSM determines the standards for training and assessment in Sexual Medicine. Successful candidates will be awarded on behalf of the MJCSM the title of “Fellow of European Committee on Sexual Medicine (FECSM)”.
In 2014, 128 physicians took part in the MJCSM exam and 104 received FECSM qualification.


The exam is set under the auspices of the UEMS but all nationalities, including countries outside the EU, are able to register for the exam. 
Eligibility will be individually assessed according to the criteria set out below. The registration forms will be reviewed by the examination committee of the MJCSM. It is essential that applicants provide all the required information when registering and that their registration form is type-written.

Who can apply?

"Fellow of the European Committee on Sexual Medicine (FECSM)" is a particular qualification in Sexual Medicine awarded under auspices of the UEMS, the EU organisation with responsibility for specialist medical practice. To be eligible to take the examination, you must be:
  • A registered medical practitioner
  • Accredited as a medical specialist in your country of practice,
  • A General Practitioner/Family Physician with more than 5 years' clinical experience of unsupervised independent practice

When registering for the exam, the applicant should deliver:

  • A fully-completed APPLICATION form
  • Proofs of medical qualifications/university graduation (in English language) authorized proofs may be requested. (upload of documents)
  • 2 letters of recommendation (from head of department or from specialist societies - only preformatted letters are accepted) (upload of documents) 
  • License to practice or equivalent registration if applicable (upload of documents)
Please be prepared to upload mandatory documents in PDF format (Proofs of medical qualifications/university graduation, two letters of recommendation according to the preformat from the website) as well as your  license to practice or equivalent registration if applicable.
Please note: 
Your registration is not complete until:
  • All required documents are received.
  • Your eligibility to sit the examination is confirmed by e-mail.
  • The registration fee is received by CPO HANSER SERVICE.

Examination format

The exam duration will be 3 hours and is likely to include 100 MCQ in 5 domains of Sexual Medicine:
1.    Basic science (including psychology) of the sexual response including sexual development
2.    General sexual issues
       a.    Impact of gender
       b.    Impact of aging
       c.    Sexual orientation
       d.    Ethical and legal aspects
       e.    Historical aspects
3.    Diagnosis and management of male sexual dysfunctions
4.    Diagnosis and management of female sexual dysfunctions
5.    Other sexual disorders
        a.    Gender identity disorders
        b.    Problematic and variant sexual behaviours
        c.    Impact of other conditions, including STI, cancer and cancer treatments
The content of the examination will be according to the curriculum of Sexual Medicine defined by the MJCSM.
The following list of topics is only a guide to the topics that will be included in the examination:
The Sexual Physician must have acquired, and must maintain, specialised knowledge in the following areas, including relevant basic sciences:
1.    Sexual development
       a)    Sexual differentiation and development, including developmental abnormalities of male and female genital and  reproductive systems
       b)    Social and cultural factors in sexual development
       c)    Psychosexual development, including the development of gender identity and sexual orientation
       d)    The incorporation of sexuality into relationships
       e)    Mating strategies and patterns of sexual behaviour
2.    Psychology and physiology of sexual response
       a)    Central and peripheral neurovascular mechanisms, including the role of higher brain centres
       b)    Role of hormones and the immune system
       c)    Genital and other peripheral responses
       d)    Orgasm, emission and ejaculation
3.    Impact of gender
       Similarities and differences between men and women in:
       a)    Psycho-physiological processes and how they are experienced
       b)    Patterns of sexual behaviour throughout life
       c)    Sexual attitudes
4.    Sexual orientation
       a)    Theories of causation
       b)    Epidemiology
       c)    Impact on sexuality, sexual response and behaviours
       d)    Evolution of socio-cultural attitudes
5.    Ageing and sexuality
       a)    The effect of physiological, psychological and socio-cultural factors on sexuality throughout life
       b)    Changes in sexual response throughout life
6.    Sexual dysfunctions in men and women
       a)    Definitions, classification and systems of nomenclature
       b)    Epidemiology, pathophysiology and risk factors
       c)    Differentiation between sexual dysfunction and short term, or transient, alterations of sexual function
       d)    Diagnosis and treatment of sexual dysfunctions
               i)    Desire disorders
               ii)    Arousal disorders
               iii)    Orgasmic disorders
               iv)    Ejaculatory disorders
               v)    Genital pain and pelvic floor disorders
               vi)    Structural/anatomical abnormalities
7.    Problematic or variant sexual behaviours
       a)    Paraphilia (exhibitionism, voyeurism, paedophilia, sadomasochism, fetishism, etc.)
       b)    Variant (behaviours other than peno-vaginal intercourse) sexual behaviours
       c)    High risk, compulsive and/or addictive sexual behaviour
       d)    Paraphilia, variant sexual behaviour and the law
8.    Gender identity disorders
       a)    Theories of causation
       b)    Definitions, classification and systems of nomenclature
       c)    Epidemiology
       d)    Diagnosis, management and standards of care
9.     Impact of other conditions on sexuality and sexual function
       a)    Somatic or psychic disorders and/or their treatment
       b)    Sexually transmitted infections
       c)    Sexual problems related to reproduction
       d)    Iatrogenic sexual problems, including the impact of drugs, surgery and radiation
       e)    Sexual violence and abuse
10.  Clinical management of sexual disorders
       a.    Principles
              i)    Evidence based medicine
              ii)    Combination of psychosomatic and somato-medical approaches
              iii)    Interdisciplinary collaboration in Sexual Medicine
              iv)    Patient- and couple-centred care
       b.    Methods
               i)    Establishing and managing a Sexual Medicine service
               ii)    Educational
               iii)    Psychotherapeutic
               iv)    Pharmacological
               v)    Physical and surgical
               vi)    Integrative care
11.     Ethical and legal aspects of Sexual Medicine
12.     Research methods related to Sexual Medicine
13.     History of Sexual Medicine

A detailed and annotated Syllabus of Sexual Medicine has been published by the ESSM Education Committee
Read more about the syllabus at

Prices and participation packages

Exam participation: 400 EUR
For the ESSM members, an attractive package fee is offered, consisting of
  • the Preparation course
  • the exam and the
  • Congress participation fee

Upcoming conference and congress 2015

International conferences and congresses that will be attended by MSASAM representatives for 2015:

1. ESSM Copenhagen  5-7 Feb 2015

2. EAU Madrid 20-24 March 2015

3. JUA Kanazawa 18-21 April 2015

4. AUA New Orleans 15-19 May 2015

5. Men's Health World Congress 9-11 October 2015


Graham Jackson, MD
Peter N. Schlegel, MD
Ridwan Shabsigh, MD
Hui Meng Tan, MD
Executive Secretary: 
Ajay Nehra, MD
Strategic Planning Committee:
Culley Carson III, MD
Larry Goldenberg, MD 
Shigeo Horie, MD
Rajeev Kumar, MD
Keith Lindor, MD
Hui Meng Tan, MD
Charalambos Vlachopoulos, MD

Featuring the 1st ICUD
on Men's Health and Infertility
Committee Chairmen Presentations
Friday, May 16, 2014
8:00 am - 5:30 pm
Featuring the ICUD on
Men's Health and Infertility
Committee Chairmen Presentations
Sunday, December 7, 2014


AUA2014 logo

Allied Health Care Professionals

World Chinese Urological Society (WCUS)

Saturday May 17
8 a.m. – 12:10 p.m.
Orange County Convention Center: W 224 G
8 a.m.-8:05 a.m.Welcome Address
Program Chair: Tom F. Lue, MD
8:05 a.m.-8:10 a.m.Scientific Program
Speaker: Run Wang, MD
8:10 a.m.-8:35 a.m.Session 1: Lo Ping-Wan Memorial Lecture
Moderator: Thomas I.S. Hwang, MD
Moderator: Richard K. Lo, MD
Moderator: Jianye Wang, MD
8:10 a.m.-8:30 a.m.Sensible Use of PSA in Early Detection of Prostate Cancer
Speaker: Gerald L. Andriole Jr., MD
8:30 a.m.-8:35 a.m.Discussion
8:35 a.m.-9:05 a.m.Session 2: Prostate Cancer
Moderator: Edmund Chiong, MD
Moderator: Hong Li, MD
Moderator: Tung Shu, MD
8:35 a.m.-8:45 a.m.The Correlation of Prostatitis and Prostate Cancer
Speaker: Qiang Wei, MD
8:45 a.m.-8:55 a.m.A Prospective Randomized Study of Prostate Cancer Detection at Repeat Biopsy: 12 vs 18 Cores Techniques
Speaker: Hio Fai Lao, MD
8:55 a.m.-9:05 a.m.Discussion
9:05 a.m.-9:30 a.m.Session 3: Basic Science in Oncology
Moderator: Benyi Li, MD, PhD
Moderator: Yeong-Shiau Pu, MD
Moderator: Liping Xie, MD
9:05 a.m.-9:10 a.m.A Switch from CD44+ cell to EMT Cell Drives the Metastasis of Prostate Cancer
Speaker: Yen-Chuan Ou, MD
9:10 a.m.-9:20 a.m.Aristolochic Acid and Upper Tract Urothelial Carcinoma
Speaker: Chung-Hsin Chen, MD
9:20 a.m.-9:30 a.m.Discussion
9:30 a.m.-9:40 a.m.WCUS Awards
9:40 a.m.-10:05 a.m.Session 4: Surgical Techniques
Moderator: Kwan Lun Ho, MD
Moderator: Chi-Rei Yang, MD
Moderator: Lee C. Zhao, MD
9:40 a.m.-9:50 a.m.One Step Robot-Assisted Nephroureterectomy in Upper Urinary Tract Urothelial Carcinoma
Speaker: Yen-Chuan Ou, MD
9:50 a.m.-10 a.m.Zero Ischemia Partial Nephrectomy
Speaker: Joseph Wong, MD
10 a.m.-10:10 a.m.Discussion
10:10 a.m.-10:40 a.m.Session 5: Urothelial Cancer
Moderator: Po Hui Chiang, MD
Moderator: George K. Chow, MD
Moderator: Albert T. Tiu, MD
10:10 a.m.-10:20 a.m.The Application of NOTES in Urology
Speaker: Xiaofeng Zou, MD
10:20 a.m.-10:30 a.m.New Strategies for the Treatment of Upper Urinary Tract Urothelial Carcinoma
Speaker: Yuantso Cheng, MD
10:30 a.m.-10:40 a.m.Discussion
10:40 a.m.-10:55 a.m.Session 6: AJA Lecture
Moderator: Eric Chung, MD
Moderator: Philip Li, MD
Moderator: Eugen Wang, MD
10:40 a.m.-10:50 a.m.How to Publish Your Basic and Clinical Research on AJA?
Speaker: Danquig Ren
10:50 a.m.-10:55 a.m.Discussion
10:55 a.m.-11:25 a.m.Session 7: ED and Peyronie’s Disease
Moderator: Christopher Ho, MD
Moderator: H. Henry Lai, MD
Moderator: Hio Fai Lao, MD
10:55 a.m.-11:05 a.m.ESWL for ED: Fact or Fiction?
Speaker: Zhong Cheng Xin, MD
11:05 a.m.-11:15 a.m.Corporoplasty Surgery for the Treatment of Peyronie's Disease
Speaker: Te Fu Tsai, MD
11:15 a.m.-11:25 a.m.Discussion
11:25 a.m.-12:05 p.m.Session 8: Men’s Health and Andrology
Moderator: Peggy SK Chu, MD
Moderator: Dominic Lee, MD
Moderator: Zhiping Wang, MD, PhD
11:25 a.m.-11:35 a.m.Chinese Andrology and Sexual Medicine: Current and Future Direction
Speaker: Hui Jiang, MD
11:35 a.m.-11:45 a.m.Sustained Weight Loss with Testosterone Replacement Therapy in Hypogonadal Men
Speaker: Farid Saad, MD
11:45 a.m.-11:55 a.m.Asian Men's Health Report and Consensus Study
Speaker: Hui-Meng Tan, MD
11:55 a.m.-12:05 p.m.Discussion
12:05 p.m.-12:10 p.m.Closing Remarks