Aging men--challenges ahead

The prolongation of life expectancy and the drastic reduction of fertility rate are the primary cause of an aging world. It is projected that the elderly (above 65) will increase within the next 25 years by 82%, whereas the new born only by 3%. Despite the enormous medical progress during the past few decades, the last years of life are still accompanied by increasing ill health and disability. The ability to maintain active and independent living for as long as possible is a crucial factor for aging in health and dignity. Therefore, the promotion of healthy aging and the prevention of disability in men, must assume a central role in medical research and medical practice as well as in the formulation of national health and social policies. Effective programs promoting health and aging will ensure a more efficient use of health and social services and improve the quality of life in older persons by enabling them to remain independent and productive. The most important and drastic gender differences in aging are related to organs and or systems dependant or influenced by reproductive hormones. In distinction to the course of reproductive aging in women, with the rapid decline in sex hormones and expressed by the cessation of menses, aging men experience a slow and continuous decline of hormones. This decline in endocrine function involves: A decrease of testosterone, dehydroepiandrosterone (DHEAQ), oestrogens, thyroid stimulating hormone (TSH), growth hormone (GH), insulin-like growth factor-1 (IGF-1), and melatonin. This decrease is concomitant with an increase of LH and FSH. In addition sex hormone binding globulin's (SHBG) increase with age resulting in further lowering the concentrations of free biologically active androgens. Interventions such as hormone replacement therapy may prevent, delay or alleviate the debilitating conditions which may result from secondary partial endocrine deficiency. Primary and secondary preventive strategies such as the promotion of a safe environment, healthy lifestyle including proper nutrition, appropriate exercise, avoidance of smoking, avoidance of drug and alcohol abuses, if done effectively, should result in a significant reduction of the health and social costs, reduce pain and suffering, increase the quality of life of the elderly and enable them to remain productive and contribute to the well-being of society. In light of this, public awareness of medical knowledge needs to be increased and basic, clinical, socio-economic and epidemiological research intensified.