‘Male Menopause’ Research
The concept of a “male menopause” and the need for hormone replacement therapy as a treatment is still highly controversial, but you wouldn’t know that from one doctor’s attempt to recruit men for his study. Jerald Bain, MD, set out to find 100 subjects to participate in his study — 900 volunteered for the chance to get a male hormone pill for what ailed them.

In the end, Bain, who is an endocrinologist at Toronto’s Mount Sinai Hospital and the director of the Health Institute for Men at the King’s Health Center in Toronto, was only able to use 30 subjects. His data has now been collected and he is analyzing it. He contends that “there is no basis for the assumption that the male hormone, testosterone, is dangerous.”

Andrew Dott, MD, and Anthony Karpas, MD, of the Institute of Endocrinology and Reproductive Medicine in Atlanta, contend that about 40% of 40-something men experience these symptoms to some degree:
• lethargy, or fatigue
• depression
• increased irritability
• mood swings
• loss of bone density
• decrease in lean muscle
• increase in fat
• anemia, or low blood levels of iron
• decreased libido
• difficulty in attaining and sustaining erections

They say that these symptoms of “male menopause,” also called andropause or viropause, can result from a decreased level of the male hormone testosterone and/or some of these risk factors:
• excessive alcohol consumption
• smoking
• high blood pressure, or hypertension
• prescription drug use
• nonprescription drug use
• poor diet
• lack of exercise
• poor circulation
• psychological problems

Not ‘Just Aging’ Anymore
According to Bain, until recently, most doctors have considered these symptoms just part of aging and have ignored them. But now, he says, “we’re beginning to realize we don’t have to accept them all. We can accept the loss of strength, but to have to lie in bed at age 60 because of weakness and fatigue is not something we should accept.”

Although men can experience a decline in testosterone levels with increasing age, and despite 150 years of attempts to rejuvenate men with hormone replacements, “male menopause” is still widely ignored. Malcolm Carruthers, a British specialist in men’s health with a practice in London, suspects that one reason is historical.

A Questionable Past
The first successful use of hormone replacement was carried out 150 years ago by a German professor named Berthold who transplanted a rooster’s testes into another castrated rooster. This procedure prevented the castrated rooster’s comb from withering away. That study was followed by numerous other experiments using testicular transplants and extracts.

Testosterone was only isolated and synthesized 60 years ago. However, the oral form can be toxic to the liver and heart, and that, Carruthers says, has “colored the thinking of two generations of physicians.”

Another problem associated with the diagnosis of “male menopause” is that only about 13% of men with symptoms have a low total testosterone level. Carruthers and others, however, say doctors need to evaluate the level of free active testosterone, or FAT, rather than total testosterone levels. FAT is obtained by dividing the total plasma testosterone level by that of the sex hormone binding globulin, or SHBG. This turns out to be low in 74% of the men with menopausal symptoms. SHBG increases with age and “zaps” the free testosterone before it can get into the cells to do its job.

Still, Skeptics Abound
Skeptics of andropause still abound. In an article in American Journal of Psychiatry, UCLA psychiatrist H. Sternbach concluded that “testosterone decline/deficiency is not a state strictly analogous to female menopause and may exhibit considerable overlap with primary and other secondary psychiatric disorders.”

British urologists N. Burns-Cox and C. Gingell concluded in another medical journal that “the symptoms of the andropause fatigue can readily be explained by stress, and there is no scientifically valid … study that shows any benefit for testosterone supplements in this uncommon group of patients.”

More Research
Carruthers, however, has been following men who have taken testosterone supplements for up to five years, and he has concluded that the supplements cause no negative effects on their hearts, livers, or prostates.

And Dott and Karpas point out that when it comes to diagnosis, doctors should not just evaluate testosterone levels. “Good medical care dictates that a comprehensive medical and psychological assessment along with a thorough laboratory assessment are necessary,” they say.

Possibly this debate will be solved once Bain completes his analysis of data comparing men with “menopausal” symptoms on hormone replacement with men receiving placebos. If so, will men rush out to get hormone replacement therapy? Stay tuned!

Blood donation may be of different kinds. In the developed countries unpaid donors give blood to replenish a community supply. In economically poorer countries, however, blood donation is carried out according to demand, as the established blood ties are extremely limited. It may be an altruistic act or it may include a cash payment or incentives other than money. A person can have blood drawn and stored for own future use.

In 1997, the World Health Organization (WHO) set a target for all blood donors to be unpaid volunteers. But statistics, in 2006, revealed that only 49 of 124 countries surveyed had achieved this target.

Typically, it is mandatory for potential donors to consent to blood donation. In the case of minors, parental consent is required. In some countries the donors may enjoy anonymity while in others it may be essential to know the ethnic background of the donor because some blood types are more common among certain races while being rare in others.

People who are potential donors are physically examined by a physician and their medical history is also examined. They will also have their blood screened for diseases that are easily transmitted through blood donations, such as viral hepatitis and AIDS.

Blood donation is rather easy and safe for most people. Some may feel faint or feel some pain when the blood is being drawn. The frequency with which blood can be drawn is dependant on various factors and also the law of the land. It may in general vary from days to month.

The amont of whole blood donated may vary between 300ml-500 ml (1 pint). Collection may be carried out manually or by using automated equipments, the latter helping to draw specific components from the blood. How often a donor can donate varies from days to months based on which component of the blood they are donating and the laws of the country where the donation takes place.

Blood components have a very short shelf life, therefore, acquiring a steady supply or stock piling blood or any of its components is a perennial problem.To circumvent this obstacle, scientist even tried their hand at transfusing blood from other animals to humans but in vain.It appears that only the blood of one human suits another. But there is more to that too as will be discussed in the coming sections.

Globally, there are tragedies happening at magnanimous scale and the demand for blood will escalate.After the September 11 tragedy the need to store blood was discussed with great fervor and the need to keep stock of a steady supply was greatly emphasized. According to 2008 estimates there was an annual collection of 81 million units of blood.

Donating blood is definitely an altruistic noble and noble gesture filling the donor with happiness and contentment.It is an intensely humanitarian act which tides over man made barriers and one of the best ways to express our love and care for our fellow beings.

Blood clotting is an important mechanism to help the body repair injured blood vessels. Blood consists of:
• red blood cells containing hemoglobin that carry oxygen to cells and remove carbon dioxide,
• white blood cells that fight infection, and
• platelets that are part of the clotting process of the body, and
• blood plasma, which contains fluid, chemicals and proteins that are key to bodily functions.

Complex mechanisms exist in the bloodstream to form clots where they are needed. If the lining of the blood vessels becomes damaged, platelets are recruited to the injured area to form an initial plug. These activated platelets release chemicals that start the clotting cascade, activating a series of clotting factors. Ultimately, fibrin is formed, the protein that crosslinks with itself to form a mesh that makes up the final blood clot.

The medical term for a blood clot is a thrombus (plural= thrombi). When a thrombus is formed as part of a normal repair process of the body, there is little consequence. Unfortunately, there are times when a thrombus (blood clot) will form when it is not needed, and this can have potentially significant consequences.

Australian fertility expert and deputy medical director of Repromed Adelaide, Dr Kelton Tremellen, says the first Australian research on Anti Mullerian Hormone (AMH) levels links a low level of this hormone with an increased risk of miscarriage.

“This link is especially apparent in young women aged under 35 years. An AMH test will give some women who have experienced recurrent miscarriage vital information on why this is occurring,” he says.

“It will also forewarn others that they may be more at risk of miscarriage, so their expectations can be managed, and they can exercise more caution.”

The AMH test, now available through Auckland and Christchurch based Repromed Clinics, also promises to help women wanting a more accurate assessment of their potential fertility.

The test allows clinicians to best assess the fertility of the remaining eggs in a woman’s ovaries (ovarian reserve), and also assists women undergoing IVF fertility treatment as a predictor of their likely response to the fertility drugs given.

The information AMH provides for women doing IVF means the potential for those at risk of severe Ovarian Hyperstimulation Syndrome (OHSS) is reduced because the clinician can more accurately adjust the drug dosage designed to stimulate their ovaries.

Repromed Auckland Medical Director, Guy Gudex says the AMH test gives women vital information about the biological age of the eggs in their ovaries.

“The biological age of a woman’s eggs may well differ from her chronological age. AMH is a more sensitive test to predict a woman’s likely chances of conceiving, particularly when used with the standard follicle stimulation hormone (FSH) test,” he says.

“FSH only lets us know if the woman has poor ovarian reserve when the quality of her eggs has already deteriorated significantly.”