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Conference Coverage
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http://www.obgyn.net/avtranscripts/FIGO_lunenfeld.htm |
"The Aging Male"
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| Dr. Roy Jackson:
“Good morning to everyone. Today we’re speaking from the FIGO meeting in Washington, D.C. and I’m honored to have with me Professor Bruno Lunenfeld who is from Israel. I am Dr. Roy Jackson, a gynecologist from Vancouver, Canada. Professor Lunenfeld, it’s an absolute honor to be with you today, I’ve read your textbooks and your articles and have followed your career in reproductive endocrinology. I understand in speaking with you today that your interests are still very much in reproductive endocrinology and your interests are changing to encompass some other areas. Are there new advances in reproductive endocrinology that you’re talking about at today’s meeting or are you presenting any other topics?” Professor Bruno Lunenfeld: “Yes, in reproductive endocrinology yesterday at the Presidential lecture, I talked about the future of gonadotropins. We are now in an era going to the quality of life and, therefore, we need more patient friendly approaches than before, not just curative or preventive but also patient friendly. So I talked about the future of the needless injections of recombinant at this age and I talked on the possibility in the future of having oral gonadotropins available which are Pepto emetics. I think we’re already at a stage where with animal experiments we can show that we’ve got very small compounds that enable about 300 daltons which can have gonadotropin activity also by the oral route and, of course, the new development of the GnRH antagonists. You know that in February 2001 we are having the 6th International Meeting on Gonotrophic Releasing Hormones, Agonists, and Antagonists in Reproduction in Cancer, and there again, we will hear a lot of new things about antagonists which really will slowly replace the antagonists in many, many subjects.” Dr. Roy Jackson: “Now Professor Lunenfeld, I understand that you’ve had this tremendous interest in reproductive endocrinology as you’ve described and you presented the papers today. You never rest, and you have a new interest that I’m very excited to be able to hear about. Maybe you can share with us this new interest that we have as gynecologists have looked after women and our focus has been women. I understand now that you’re looking at a different aspect. Can you tell us more about this?” Professor Bruno Lunenfeld: “Yes, about thirty-five years ago I was together with Bob Grimlot when the Menopause Society was created. When I retired from my clinical work at the Sheba Medical Center in Israel seven years ago, I decided that we men are underprivileged. Men live seven years less than women live, and men have health problems and rarely are not aware of them. Women go for prevention, and women are trained for prevention. Women have their gynecologists and confidantes, and they can talk with them about many, many personal things. Men don’t have a men’s health physician. They go to the urologist for repair, and they go to the internist for repair. They don’t go for prevention because from the very, very beginning the mother will tell a boy – ‘You’re a boy; you are not suppose to cry. You shouldn’t be like a girl running because you have some pain.’ Women are geared for prevention; they’re healthy when they go to the gynecologist to remain healthy. They’re healthy when they go during their pregnancy to the obstetrician in order to have a healthy and good pregnancy, and they go with their child to the pediatrician in order to keep the child healthy. Men only go for repair so women use the health service fifty-percent more than men but men cost the health service much more because they go too late. Men don’t talk about their diseases but we got lucky because indirectly with the era of Viagra, men suddenly started talking and opened this up. Five years ago in London we registered the International Society for the Study of the Aging Male called ISSAM. It’s actually a website; it’s issam.ch and we already had two World Congresses. About 300 people came to the first World Congress together with the World Health Organization in Geneva. This year in February of 2000, we had 750 people come, and the next Congress will be in Berlin in 2002, and we expect about 1,500 people. So I think the awareness is coming around, men are ready to go and talk about their health problems. We have our own journal, The Aging Male, and I can tell you that the first gender specific health report was published by the World Health Organization together with ISSAM in the March issue of The Aging Male, and it’s actually the first health report on men.” Dr. Roy Jackson: “Now as gynecologists, we’ve always worried about cardiovascular disease, osteoporosis, and libido problems that women have suffered from. Do you think this impacts and has implications on men as well?” Professor Bruno Lunenfeld: “Certainly, just like estrogens protect women from Alzheimer’s disease, osteoporosis, and cardiovascular disease, estrogens also metabolize from testosterone and protect men in the same way. In women there is a big problem, with menopause suddenly and abruptly estrogen production ceases. In men lytic function goes down but slowly, therefore, men still produce testosterone until a very late age and this testosterone can be metabolized into estrogens. That’s why osteoporosis and Alzheimer’s disease in men occurs later so we have an advantage here. We could of course increase our advantage if men would be ready to look after themselves, exam themselves, go to the doctor for prevention, and try to do this because many things can be done. We have evidence-based medicine today which can show the effect of testosterone, we have lots of research going on dehydroepiandrosterone, and there is lots of research going on in the effect of glucosamine and aging. But what we have today and what we can do is physical exercise. Physical exercise alone - if we talk of aerobic/anaerobic instruction - can already be an enormous help to keep people fit and healthy.” Dr. Roy Jackson: “So who do you foresee doing the preventative healthcare for men? Who’s going to provide this healthcare - is it going to be the family doctor, the urologist, or the gynecologist, and is our population base going to change?” Professor Bruno Lunenfeld: “Look, maybe the gynecologists is a subject because what happens many times is that the woman comes to the gynecologist and tells him, ‘You have helped me so much, you’ve given me HRT, I’m doing very well now but what about my husband?’ So he will probably be the first person to hear about the problem but he’s not geared for the urology problems men have, and not for the cardiovascular or the psychological problems. I think we will have to slowly create a men’s health physician, this could start from urology but this would mean that urology like gynecology thirty-five years ago would have to go in what we call medical urology. They would have to learn more about internal medicine, the urologist would have to learn more about endocrinology, and they would have to learn more about social and psychological problems. I think maybe in the future there will be some kind of medical urologist who will be at least in the first part of the next century a men’s health physician but probably later we will have to create a pure men’s health physician.” Dr. Roy Jackson: “Now maybe in closing, Professor Lunenfeld, we often refer to the menopausal woman as the mature woman because of the fact that it’s more politically correct to refer to them as the mature woman. Do you think we’re now going to be referring to these men as the mature men?” Professor Bruno Lunenfeld: “The seniors.” Dr. Roy Jackson: “The seniors.” Professor Bruno Lunenfeld: “But my main final message is use it or lose it. It is true for the brain, it’s true for the muscle, and it’s true for the penis.” Dr. Roy Jackson: “Professor Lunenfeld, I thank you very much for the privilege of sharing some very exciting information with us today, and I do hope you enjoy your stay in Washington, D.C.” Professor Bruno Lunenfeld: “Thank you very much.” Dr. Roy Jackson: “Thank you.” |