madman
Super Moderator
Author Block: Michael Zitzmann, MD,PhD, FRSM, FECSM, Claudia Krallmann, MD, Jann Cremers, MD, SABINE KLIESCH, MD, Simone Bier, MD. University of Muenster, Muenster, Germany.
Disclosure Block: M. Zitzmann: None. C. Krallmann: None. J. Cremers: None. S. Kliesch: None. S. Bier: None.
The relevance of fertility and sexual wellbeing in aging men is rising. Notwithstanding, little is known especially about the fertility of healthy aging men. There are reports about a decline in ejaculate volume, sperm concentration, total sperm count, motility, and normal morphology with age. Functional hypogonadism—characterized by low testosterone, loss of libido, erectile dysfunction, and fatigue—is also well-documented, especially in men with poor metabolic health or diabetes mellitus.
Question
Do reproductive functions, parameters of sexuality and levels of sex hormones decline in healthy aging men, and are there predictors for such changes?
Design
Longitundal observational study. In 2014, we recruited 200 healthy men (no history of cancer, cardiovascular events, diabetes mellitus). In 2020, 117 participants returned for follow-up evaluations, allowing longitudinal analysis of above named parameters and influencing factors using linear regression models.
Participants/Methods
Parameters of healthy men aged 18–85 at baseline were compared utilizing 2-level linear mixed regression models. Assessments included semen analysis according to WHO standards, sex hormone profiling (LH, FSH, SHBG, total and free testosterone), and metabolic assessments. Participants completed validated questionnaires on erectile function (IIEF-EF) and aging-male symptoms (AMS score).
Results
Within the total cohort, hormone levels remained within normal range, albeit serum concentrations of total and free testosterone decreased in those men exhibiting an increment in BMI (p=0.004, p=0.002) or HbA1c (p=0.003, p=0.001). Semen parameters (volume, total sperm count, concentration, vitality) remained within normal ranges without significant changes. However, progressive sperm motility declined significantly in participants over 65 years (p=0.002), this being associated with increases in HbA1c (p=0.008, of which total values remained all below 6.5%). EF exhibited a decline in participants older than 45 years (p=0.001), albeit only in men exhibiting increases of HbA1c (p=0.002), while shifts in total or free testosterone (p=0.52, p=0.47) were not associated with EF. AMS-scores, and their sexual subdomain (loss of libido), were significantly affected by decreasing levels total or free testosterone (p=0.04, p=0.003), this being an effect of increasing HbA1c levels (p=0.002) but not ageing as such (p=0.57).
Conclusion
In healthy ageing men without developing diabetes mellitus, increases of HbA1c appear to influence sexual wellbeing and sperm motility. However, healthy men without deterioration of the metabolic state experience minimal declines in fertility, sexual wellbeing and sex hormone levels with age.
Disclosure Block: M. Zitzmann: None. C. Krallmann: None. J. Cremers: None. S. Kliesch: None. S. Bier: None.
The relevance of fertility and sexual wellbeing in aging men is rising. Notwithstanding, little is known especially about the fertility of healthy aging men. There are reports about a decline in ejaculate volume, sperm concentration, total sperm count, motility, and normal morphology with age. Functional hypogonadism—characterized by low testosterone, loss of libido, erectile dysfunction, and fatigue—is also well-documented, especially in men with poor metabolic health or diabetes mellitus.
Question
Do reproductive functions, parameters of sexuality and levels of sex hormones decline in healthy aging men, and are there predictors for such changes?
Design
Longitundal observational study. In 2014, we recruited 200 healthy men (no history of cancer, cardiovascular events, diabetes mellitus). In 2020, 117 participants returned for follow-up evaluations, allowing longitudinal analysis of above named parameters and influencing factors using linear regression models.
Participants/Methods
Parameters of healthy men aged 18–85 at baseline were compared utilizing 2-level linear mixed regression models. Assessments included semen analysis according to WHO standards, sex hormone profiling (LH, FSH, SHBG, total and free testosterone), and metabolic assessments. Participants completed validated questionnaires on erectile function (IIEF-EF) and aging-male symptoms (AMS score).
Results
Within the total cohort, hormone levels remained within normal range, albeit serum concentrations of total and free testosterone decreased in those men exhibiting an increment in BMI (p=0.004, p=0.002) or HbA1c (p=0.003, p=0.001). Semen parameters (volume, total sperm count, concentration, vitality) remained within normal ranges without significant changes. However, progressive sperm motility declined significantly in participants over 65 years (p=0.002), this being associated with increases in HbA1c (p=0.008, of which total values remained all below 6.5%). EF exhibited a decline in participants older than 45 years (p=0.001), albeit only in men exhibiting increases of HbA1c (p=0.002), while shifts in total or free testosterone (p=0.52, p=0.47) were not associated with EF. AMS-scores, and their sexual subdomain (loss of libido), were significantly affected by decreasing levels total or free testosterone (p=0.04, p=0.003), this being an effect of increasing HbA1c levels (p=0.002) but not ageing as such (p=0.57).
Conclusion
In healthy ageing men without developing diabetes mellitus, increases of HbA1c appear to influence sexual wellbeing and sperm motility. However, healthy men without deterioration of the metabolic state experience minimal declines in fertility, sexual wellbeing and sex hormone levels with age.
