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CHAIRMAN'S
REPORT
The 4th International Conference of the Society for the Study of
Androgen Deficiency was held in the Royal Society, London. This
conference was the largest to date with delegates and speakers from
over 20 countries worldwide.
The conference was entitled 'Androgens in Active Ageing' and we
were honoured to have Prof Bruno Lunenfeld and Prof Focko Rommerts
open the conference with two talks, giving an overview of ageing
and androgens. Prof Lunenfeld spoke on 'Managing Ageing in the 21st
Century', emphasising the challenge of maintaining health in an
ever-increasing older population. In particular he discussed the
important policy and strategic decisions to be taken by governments
in the face of changing economic, cultural and environmental shifts.
He emphasised the frailty syndrome of old age and how to alleviate
its effects. Prof Rommerts spoke from the perspective of testosterone
biosynthesis and enlivened the audience by passing a bottle of androgen
chemical for the audience to smell. He pointed out that not everyone
was equipped to smell the scent, and not everyone admitted to being
able to do so!
The programme was extensive and papers were presented on many of
the important areas of health influenced by androgens. Advances
in the treatment of erectile dysfunction were discussed in the work
of Prof Andrea Garolla from Italy who has studied the role of testosterone
in 700 men. Professor Svetlana Kalinchenko described the mechanism
of erectile dysfunction in diabetic patients and the positive role
of alpha-lipoic acid in its treatment. Dr Farid Saad outlined the
potential for testosterone in treating metabolic syndrome, and evidence
presented to suggest that some metabolic features could be ameliorated
by exogenous testosterone. Risk factors associated with metabolic
syndrome were described in the prospective population based health
survey from Tromso in Norway (Prof Johan Svartberg), showing that
a serum testosterone level in the normal range was beneficial. Further
clinical studies from Prof Kevin Channer (Sheffield, UK) elucidated
the effect of testosterone on the heart and showed a benefit for
testosterone replacement in ischaemic heart disease.
Several papers (Prof Ralph Martins, Prof Eva Hogervorst) discussed
the effect of testosterone on the brain in Alzheimer's disease and
dementia. Low testosterone levels are an independent risk factor
for Alzheimer's disease and cognitive decline in men, however testosterone
replacement therapy has not always shown positive effects on cognition.
The challenge of using androgens to maintain health in the elderly
was taken head on in a thoughtful presentation from Prof Robert
Tan of the University of Texas, where he looked at what a low testosterone
level means and how to study its effects on illness in old age.
Prof Lothar Heinemann gave his experiences with the Aging Males
Symptom Scale, which he has developed to help in diagnosis, while
Dr Mike Wheeler gave an excellent critique on currently available
androgen assays. Dr Wolfgang Ziemann described his assay for free
salivary testosterone, which gives very precise and accurate results.
Dr Andrew Baranowski described the causation and management of genital
pain in men and Dr Roger Minkow described how long distance cyclists
are at risk from reduced penile perfusion due to pressure from the
bicycle saddle. In a probing analysis of androgens and the prostate
Dr Mark Feneley lifted the curtain on recent understanding of androgen
sensitivity for prostatic neoplasia showing that understanding of
this important disease is advancing rapidly.
Dr Eugene Shippen explored the role of oestrogen in men, emphasising
that oestrogen effects are at the core of many health mechanisms
such as neural growth and regeneration, vascular tone, insulinotrophic
effects, collagen synthesis, and control of inflammatory cytokines.
Dr Lee Vliet continued with a talk on the metabolic syndrome in
women, emphasising endocrine imbalances at the time of the climacteric.
In a second talk she described the importance of the balance of
androgens and oestrogens for health in women. Prof Abdulmaged Traish
outlined the role of androgens in women with the enticing prospect
of advancements in knowledge to allow evidence-based management
of women's sexual dysfunction with androgen therapy. Dr Shippen
elaborated on the role of testosterone in modulation of inflammation,
which may be of practical importance in the near future. Dr Clem
Williams described his experience, in Canada, with the new PDE5
inhibitors in erectile dysfunction.
In the Cynthia Read seminar, in the final session of the conference,
Dr Christian Pike from Los Angeles focused on age-related testosterone
depletion and the development of Alzheimer's disease, setting the
scene for Prof Michael Zitzmann to describe the androgen receptor,
holding out the prospect of individualised testosterone substitution
therapy by adjusting the dose to the androgen receptor polymorphism.
During the meeting there were thirteen posters on view, displayed
around the Royal Society. The meeting finished with an open discussion
on developments in andropausal medicine around the world, delivering
an upbeat message of basic science being translated into new and
exciting therapies for the future.
Our thanks go out to all the speakers for their excellent original
presentations and to all the participants for bringing this 4th
International Conference alive with objective intellectual enquiry.
Also our grateful thanks to the organising committee for unstinting
hard work in making the conference a reality. To the staff and management
of the Royal Society we say thankyou for allowing us to hold our
premier meeting in such splendid surroundings and to our sponsors
and supporters, without whom the conference would not have taken
place, we express our deepest gratitude.
Dr TR Trinick
Chairman.
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