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Introduction Objectives Materials and methods Results Discussion and conclusion Several robust epidemiological studies suggest that men are often engaged in sexual relationships with younger women with a variable, age‐dependent age difference. However, the ageing process determines a significant worsening of the andrological status, which favors the onset of erectile dysfunction and hypogonadism.To analyze the effects of differences in age between the partners [delta (Δ) age (M − F)] on patients referring to the Andrology Unit of Careggi University Hospital for male sexual dysfunction.A monocentre cohort of 4055 male subjects was evaluated by SIEDY structured interview. The cross‐sectional analysis assessed the psychobiological and relational correlates. The rate of forthcoming major cardiovascular events (MACE) was investigated in the longitudinal analysis. All the models have been adjusted for age, education, lifestyle, and chronic disease score.∆ age (M–F) shows a stepwise increase, according to the increasing age bands of the male partner. ∆ age (M–F) was associated with a greater number of children, at the cost of more conflictual relationships within the family. The phenotype of these relationships is characterized by the report of a partner with a higher sexual desire and a higher ability to reach climax. Men seeking a younger partner show more often a histrionic personality (p = 0.023) and higher testosterone levels (p = 0.032). However, having a younger partner doesn't improve the ability to obtain a full erection. Kaplan–Maier analysis of a longitudinal subgroup of patients followed longitudinally (N = 1402) for 4.3 ± 2,59 years, showed that patients in the fourth quartile had a higher rate of forthcoming MACE versus those in the first quartile (p = 0.005).In subjects with sexual dysfunctions (as in the general population) age‐different relationships increase as a function of male ageing. A greater Δ age (M–F) is associated with specific men and relationship features and a higher risk of MACE. [ABSTRACT FROM AUTHOR]

Functional hypogonadism is frequently found in obese men, particularly those with metabolic complications. Several possible therapeutic approaches could be considered. An extensive search on Medline, Embase, and Cochrane databases was performed to retrieve the available studies assessing the change of testosterone (T) and sexual function upon dieting or physical activity programs, as well as glucagon-like peptide 1 analogues. The role of lifestyle interventions associated with T replacement therapy (TRT) was also evaluated. The expert opinion provided here has been corroborated by meta-analyzing the results of the retrieved studies. Current evidence supports the beneficial role of lifestyle modifications in increasing T and improving sexual function as a function of weight loss. While dieting programs are associated with greater effects in younger populations, physical exercise has major effects in older ones. Among the dieting programs, a very low-calorie ketogenic diet shows the best results; aerobic or endurance physical exercise perform similarly. The advantages of functional hypogonadism in lifestyle modifications are empowered by the association with TRT. Therefore, TRT may be a valuable complementary strategy to increase muscle mass and facilitate physical exercise while improving sexual symptoms, thus favoring the motivation and compliance for lifestyle interventions. [ABSTRACT FROM AUTHOR]

Background: Although it has been assumed that chronic cannabis use may have an unfavorable impact on male sexual function and its metabolic correlates, evidence from clinical studies remains inconclusive. Objective: To investigate the relationship between cannabis use and sexual behavior, anthropometrics and metabolic/vascular profiles in a large series of men evaluated for sexual dysfunction. Methods: A total of 4800 men (mean age 50.8 years) attending an andrology outpatient clinic for sexual dysfunction were studied. Sexual symptoms, hormonal, metabolic, and instrumental (penile color Doppler ultrasound, PCDU) parameters were evaluated according to the reported habitual use of recreational substances (no use, 1–2 joints/week, >2 joints/week, and use of illicit drugs other than cannabis). Results: When compared with non‐users, cannabis users were younger and exhibited a lower prevalence of comorbidities as well as better PCDU parameters, despite reporting higher alcohol and tobacco consumption. After adjustment for confounders, cannabis use was associated with a greater instability in the couple's relationship and a higher frequency of masturbation. In addition, the group smoking >2 joints/week showed a significantly lower body mass index than both controls and users of substances other than cannabis. Men who reported using recreational drugs (either cannabis or other) exhibited significantly lower levels of both total and low‐density lipoprotein cholesterol than non‐users. At the PCDU, smoking 1–2 joints/week was associated with significantly higher dynamic peak systolic velocity than both non‐drug use and use of >2 joints/week. Prolactin levels were significantly higher in individuals smoking 1–2 joints/week and in those who used substances other than cannabis when compared with controls, whereas no difference in total testosterone levels was observed. Discussion: In men with sexual dysfunction, mild cannabis consumption may be associated with a more favorable anthropometric and lipid profile and with a better penile arterial vascular response to intracavernous prostaglandin injection. [ABSTRACT FROM AUTHOR]

Introduction: Obesity negatively impact on the metabolism of sex hormones, leading to reduced testosterone serum levels. However, how the obesity could negatively impact on the overall gonadal function, particularly on male fertility, remained unclear so far. Objective: To systematically review evidences regarding the influence of body weight excess on the sperm production. Methods: A meta‐analysis was conducted, searching all prospective and retrospective observational studies reporting male subjects older than 18 years old, with body weight excess from overweight to severe obesity were considered. Only studies using the V edition of the World Health Organization (WHO) manual for semen analysis interpretation were considered. No specific interventions were considered. Search was focused on studies comparing overweight/obese to normal weight subjects. Results: Twenty‐eight studies were considered. Total sperm count and sperm progressive motility were significantly lower in overweight compared to normal weight subjects. Meta‐regression analyses demonstrated that patients' age impacted on sperm parameters. Similarly, obese men showed lower sperm concentration, total sperm number, progressive and total motilities, and normal morphology lower than normal weight subjects. Reduced sperm concentration in obese men was influenced by age, smoking habit, varicocele, and total testosterone serum levels at meta‐regression analyses. Conclusions: The male potential fertility is reduced in subjects with increased body weight, compared to normal weight men. The higher was the increased body weight, the worst was the sperm quantity/quality. This result comprehensively included obesity among non‐communicable risk factor for male infertility, shedding new lights on the negative impact of increased body weight on overall gonadal function. [ABSTRACT FROM AUTHOR]

Background: The level of education has been recognized as a cardiovascular risk factor; nevertheless, it is often neglected in cardiovascular risk prediction. Objectives: To evaluate the psychobiological correlates of the level of education and if it could predict incident major adverse cardiovascular events in men consulting for erectile dysfunction. Methods: Total 3733 men (49.8 ± 13.7 years old) attending an andrology outpatient clinic for erectile dysfunction were studied. Sexual and psychological symptoms, hormonal and metabolic, as well as instrumental (penile color Doppler ultrasound) parameters were evaluated according to the education level (university, upper secondary, lower secondary, and primary degree). For a subset of 956 patients, data on incident major adverse cardiovascular events were retrospectively collected for 3.9 ± 2.4 years. Results: As compared with men with university degree, those with a lower education had an increased frequency of moderate–severe erectile dysfunction (odds ratio = 1.21 [0.99;1.48], 1.41 [1.14;1.73], 1.70 [1.26;2.30] for upper secondary, lower secondary, and primary school, respectively) and reduced flaccid peak systolic velocity at penile color Doppler ultrasound. Men with a lower level of education tend to suffer from metabolic syndrome (odds ratio = 1.38 [1.06;1.79], 1.73 [1.34;2.24], 1.72 [1.24;2.37] for upper secondary, lower secondary, and primary school, respectively) and were more likely to have history of previous cardiovascular events. In the longitudinal study, men with a higher level of education had a significantly lower incidence of major adverse cardiovascular events. The role of higher education as an independent predictor of major adverse cardiovascular events was established by multivariable Cox regressions (hazard ratio = 2.14 [1.24–3.69]). Discussion: In erectile dysfunction subjects, lower level of education is associated with a more severely impaired erectile function with atherogenic pathogenesis and with a worse cardio‐metabolic profile. In addition, a lower level of education predicts forthcoming major adverse cardiovascular events. Therefore, education level should be considered as a costless but valuable information in the assessment of cardiovascular risk in patients with erectile dysfunction. [ABSTRACT FROM AUTHOR]