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In an electronic vote of  600 delegates held by Ferring Pharmaceuticals, 

	Reduced Libido and Erectile Dysfunction  were voted the  most significant symptoms of the andropause
	Over 80% voted in favour of prescribing Testosterone Replacement Therapy to men over 50
	0nly 2% would not consider prescribing it because of concerns about prostatic disease
	Only 3% would not consider prescribing it because of concerns about cardiovascular disease
	Nearly 75% thought there was sufficient evidence to initiate treatment for osteoporotic aging males

Report from the Second World Congress on the Aging Male held in Geneva 9-13th Feb 2000

by Dr Malcom Carruthers,   e-medicine Andrology Center, Harley Street, London, UK

and Dr Michael Hansen, European Organisation for the Control of Circulatory Diseases (EOCCD), Copenhagen, Denmark.

The Second World Congress on the Aging Male held in Geneva 9-13^th February is likely to be regarded as a turning point in the history of Male Hormone Replacement treatment with testosterone. 600 leading experts in the field, mainly urologists, endocrinologists, gynecologists and research scientists from all over the world, were invited to a symposium called "Testosterone Deficiency as a Real Clinical Issue in the Aging Male Population", organised and sponsored by Ferring AG Pharmaceutical company. This emminent jury came out over-whelmingly in favour of testosterone treatment being important, beneficial and safe.

Given electronic vote recorders for instant analysis of their views, they were asked the following ten questions:

1.    What do you consider a subnormal testosterone level?

Given a choice of 4, 8 and 12 nmol/l, the vote split evenly between the three levels, with a slight preference for the highest. This confusion may have resulted from lack of clarity over whether the question referred to total or free testosterone, and the schism between units of measurement used in different countries. Many of the large contingent of US and Canadian delegates were unable to equate 12 nmol/l total testosterone, the more favoured lower limit of normal in Europe, with the level of 310ng/dl used by doctors trained in North America.

The delegates were asked to rank the symptoms of loss of libido, reduced cognitive function, reduced muscle strength, decreased bone mineral density, depression, and erectile dysfunction in order of importance. Reduced libido and erectile dysfunction were the most highly rated.

Subnormal testosterone levels (<10nmol/l) accompanied by symptoms, rather than subnormal levels alone or with raised gonadotrophins was considered the most appropriate by nearly 75% of delegates.

Over 80% voted in favour of doing so.

Oral tablets were used by around 60%, intra-muscular injections by over 50%, transdermal body or scrotal patches by only about 10% each, and pellet implants by less than 5%. This suggests that men find patches inconvenient and irritant, and injections are the main form of testosterone treatment in the USA, where unlike Canada, Europe, and most of the rest of the world, safe oral forms of testosterone are not available yet, though hopefully this will soon change.

Oral treatments followed by injections were by far the most favoured forms of treatment.

Effective symptom relief was most highly rated at nearly 35%, with ease of use and convenience and examination for pre-existing disease at around 25% each, and cost, lifestyle and availability at less than 10% each.

Over 75% of delegates said they would start treatment, but carefully monitor the PSA,  6% would await the outcome of stringent risk/benefit analyses and only 2% would not consider prescribing it because of the concerns about prostatic disease.

Nearly 70% were confident that the potential benefits outweighed the risks, less than 30% wanted to await the outcome of more stringent risk/benefit analysis, and only 3% would not consider prescribing it because of concerns about cardiovascular disease.

Nearly 75% did think there was sufficient evidence to initiate treatment for osteoporotic aging males.

These views represented a dramatic shift of opinion in favour of testosterone treatment even over the two years since the First World Congress on the Aging Male held in Geneva two years ago. Then opinions were much more evenly divided between those in favour and those wishing for a lot more evidence before they would consider starting their patients on testosterone.

The most important point about the Second Congress is that the majority of experts seemed to think that evidence had been produced to their satisfaction, and they now felt confident about beginning treatment.

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