| Objective: At first, to establish preliminarily a set of evaluation parameter system for reproductive health of middle and aging males in China, which is applied to population for evaluating and comparing reproductive health both within and between communities. The second study is to investigate the knowledge, attitude, needs and practice of the related diseases to androgen deficiency, and to explore the treatment and use of androgen preparations. The third one is to investigate change of serum reproductive hormones with male aging and differences of the hormones among age groups or between healthy middle and aging males living in the township and rural communities. The final one is to explore the screening positive rate and prevalence rate of late onset of hypogonadism in males (LOH), to investigate the sensitivity, specificity and applicability of the screening scales (ADAM/AMS) on Chinese population.Methods: An alternative questionnaire framework was emerged by Delphi method and then assessed by experts and managers, providers and clients of male reproductive health at the grass roots, respectively. And finally the evaluation system formed through score, sort and screening. On the basis of community population, the survey was carried out by cluster and following stratified sampling methods. A total of 1498 middle and aging males were surveyed by the unified structured questionnaire, which originated from the expansion of the indexes on the evaluation system, aged between 40 and 69 years. Thereafter, 1461 qualified questionnaires were obtained in the second research, the related datum of awareness and therapy on androgen were obtained through the analysis of questionnaires. 434 healthy middle and aging males were recruited in the third research. The concentrations of reproductive hormone were assayed to explore the characteristics on their change. A total of 1472 qualified questionnaires were obtained in the final study. According to results of serum androgen level setting the cut-off point on LOH diagnosis, the screening positive rate and prevalence rate of LOH, sensitivity, specificity and applicability of the screening scales were investigated.Results: Indexes of the alternative questionnaire framework were classified as essential, supplemental and referral categories respectively covering 11, 15 and 14 indexes after consideration of total and average scores. The middle and aging males awareness rates about androgen and LOH were 27.71% and 67. 39%, respectively. Only 2 men from rural group had accepted examination of serum testosterone. Moreover, the numbers of the users to the prescription and supplement therapy of androgen preparation were 1 and 4 men in the two groups, respectively. The prevalence rate of fracture related osteoporosis within recent 5 years was 4. 18% and 13 men had the experience of bone density scan. The serum TT levels did not change significantly with male aging while serum LH and SHBG levels gradually increased, but, cFT, Bio-T, TSI and FTI levels gradually decreased with male aging. There was no correlation between serum TT levels and aging, and LH levels. There was notably a positive correlation between serum LH, SHBG and aging, while there was a negative correlation between cFT, Bio-T, TSI, FTI and aging, and LH levels. Moreover, SHBG positively correlated with LH. There were statistical differences in serum LH, TSI, FTI (P<0.05), cFT and Bio-T (P<0.01) in the age-matched group of 40 to 49 years between the township and the rural residents. Interestingly, serum LH, SHBG, cFT, Bio-T, TSI and FTI in the group of 40 to 49 years had more rapid rate of increase or decrease in the rural residents than the township residents, however, the result was converse in the groups of 50 to 59 years and 60 to 69 years. The screening positive rate of ADAM and AMS was 80. 77% and 32. 34%, respectively. The LOH prevalence rate was 37. 85% or 15. 42% on subjects had symptoms. According to cFT cut-off point, the sensitivity of ADAM and AMS was 86. 63% and 35. 29%, the specificity was 24.48% and 63.49%, respectively. The cut-off point of AMS score was 19.5 by means of prediction of ROC curve. In addition, there was no correlation between cFT and AMS score.Conclusion: The classified indexes were characterized by their wide-range involvement and outstanding representative. This evaluation parameter system for reproductive health of middle and aging males may be suitable to both rural and urban community population in China. The middle and aging males' awareness rates about androgen was low. Similarly, the use rate of androgen, the prevalence rate of fracture related osteoporosis and use rate of bone density scan were lower, however, the awareness rates of LOH was higher relatively. The serum TT levels did not change significantly with male aging while serum LH, SHBG, cFT, Bio-T, TSI and FTI levels had the gradient change with aging. There were statistical differences in many parameters of serum reproductive hormones among the age groups or between the township residents and the rural residents. The screening positive rate and LOH prevalence rate of ADAM exceeded to that of AMS. The sensitivity of ADAM was higher and its specificity was lower, however, the results of AMS were converse. The combined use of two scales for the screening, diagnosis and monitoring of LOH can be suitable for clinical application. |
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