Berzelius Symposium: Aging Male, Abstracts

E DiczfalusyKarolinska Institutet,Stockholm, Sweden

on the muscle. Further studies are needed to

determine whether testosterone or SARMs can

induce meaningful improvements in physical

function and patient-important outcomes in

patients with physical dysfunction associated

with chronic illness or aging.

doi: 10.1016/j.jomh.2008.06.011

A brave new world for brave old men

E. Diczfalusy

How beauteous mankind is !

O brave new world

That has such people in’t!

The Tempest (1611)

act 5 sc. 1, 1, 182.

Abstracts and presentations are different. This is a

rather unorthodox abstract to introduce some-

what unusual reflections on our common

future, the Big Unknown.

Look back to look forward ! In an address to the

Royal College of Physicians (London, 1944) Win-

ston Churchill remarked that ‘‘the longer you

can look back, the further you can look for-

ward’’. Let’s follow his advice and look back, say

1.6 million years to the pleistocene epoch when

some primitive humans first established them-

selves on this Earth. Geohistorians say that it

had taken a million years or so before they

started cooking their food and another half-a-

million years before homo sapiens neanderthalensis

introduced the burial of cadavers. Viewed

against this background, it seems almost

incredible that the acquisition of agricultural

and other technology is generally believed to

have occurred only in the holocene epoch,

around 12 000–15 000 BC.

From holocene to anthropocene. Anthropocene is a

neologism to indicate the most recent period in

the life of Earth, (maybe the last 50–60 years)

when – for the first time in history – the impact

of human activities on the environment

reached the same dimensions as that of natural

forces. Today homo sapiens is significantly chan-

ging his environment and his own develop-

ment. Will he be able to do it in a responsible

way?

Population growth; too slow and too rapid ? Some

2000 years ago, when Emperor Augustus died

(AD 14) the known world population was less

than 300 million people and it remained at that

level for the next 1000 year or more. Even 500

years before our time the global population was

only around 400 million people. Then the

growth accelerated: by the year 1900 popula-

tion had reached 1600 million, by 1960 it

increased to 3000 million and by the year

2000 to 6000 million. When I was born, in

1920, world population was still less than

2000 million; today it exceeds 6500 million

people. Hence, in my lifetime I have seen the

birth of another two worlds, equal in numbers,

needs, aspirations, hopes and dreams about a

brighter future. . .

What next ? Quo vadimus ? Between 2005 and

2050 world population is projected to increase

from 6500 million to some 9200 million peo-

ple; that of Africa from 900 to more than 1900

million, and that of Asia from 3900 to 5200

million, whereas the population of Europe is

expected to diminish from 731 to 653 million

people. Whereas the European population out-

numbered that of Africa 2.5 times in 1950, in

2050 there will be three times more people in

Africa than in Europe. May this result in major

population shifts? This is a subject much dis-

puted today by students of geopolitics.

Ageing rapidly; where is the end ? ‘‘Old age is the

most unexpected of all the things that happen

to a man’’ said Leon Trotsky (1935) and it

would appear that the rapid ageing of the

global population was an even more unex-

pected surprise to mankind. The United

Nations project that between 2000 and 2050

the global population aged 65 years and over

will increase from 6.9 to 16.2% of the total. It is

expected to increase from 3.3 to 6.9% in Africa,

from 5.8 to 17.5% in Asia and from 14.7 to

27.6% in Europe. During the same period, the

proportion of octagenarians (aged 80 and

over) is projected to increase worldwide from

1.1 to 4.4% and in Europe from 2.9 to 9.6% (in

countries like Italy and Germany to more than

13%).

Retirement age; fact, or fiction ? The very first Old

Age and Disability Insurance Bill was adopted

by the Prussian Parliament in 1889 for workers

who reached the age of 70 years. In 1889 life

expectancy at birth for Prussians was 45 years.

In short time many countries followed this

example, and established retirement ages gen-

erally at 65 years, which remained unchanged

Vol. 5, No. 3, pp. A2–A19, September 2008 A7

Berzelius Symposium: Aging Male, Abstracts

A. GiwercmanReproductive MedicineCentre, Lund University,Sweden

A8 Vol. 5, No. 3, p

for more than a century, but life expectancy at

birth didn’t. Worldwide life expectancy in

1950 was close to that in Prussia in 1889;

45.0 years for men and 47.8 years for women.

However, by the year 2005 it increased by 20.0

years for men and 21.7 years for women and

between 2005 and 2050 an additional increase

of 8.1 years is projected for men and 8.3 years

for women. By the year 2050 European life

expectancy at birth is expected to reach 77.8

years for men and 84.2 years for women. Has

the time come to reassess and reform?

Children, grandchildren and grandparents: In 1950

more than 34% of the world population con-

sisted of children (people less than 15 years of

age); for 2050 their proportion is projected to

decline to 19.8% and in Europe to 14.6% (In

countries like Bulgaria and Poland to less than

12.5%). Hence, in tomorrow’s brave new world

there might be too many grandparents for too

few grandchildren. . .

What about our median age ? Median age is an

imaginary line, dividing a population into two

equal parts; those who are older and those who

are younger. It is expected to increase if the

number of children decreases and/or the num-

ber of elderly people increases. In 1950 world-

wide median age was 23.9 years (and in Europe

29.7 years) which is expected to increase by the

year 2050 globally to 38.1 years (and in Europe

to 47.3 years).

p. A2–A19, September 2008

From evolution to progress. By definition, progress

can never go wrong, whereas evolution fre-

quently does, and – for the time being – certain

areas of human activities still exhibit more

evolution than progress whereas the opposite

is true for others. Our political, moral and

ethical evolution may serve as examples com-

pared to our scientific and technical progress.

The latter is masterfully characterized by

Lesher and Howick in a NASA Report (vintage

1966): ‘‘Eight hundred life spans can bridge

more than 50,000 years. But of these 800 peo-

ple 650 spent their lives in caves or worse: only

the last 70 had any truly effective means of

communicating with one another, only the

last 6 ever saw a printed word or had any real

means of measuring heat or cold, only the last

4 could measure time with any precision; only

the last 2 used an electric motor; and the vast

majority of the items that make up our mate-

rial world were developed within the life of the

eight-hundredth person’’. Since 1966 the

amount of new information has doubled every

6 to 7 year. Thus it seems justifiable to state

that the scientific progress achieved by homo

sapiens in the past 50 years is at least as much

as, if not more than, that of all preceding

generations during 50,000 years. ‘‘What is past

is prologue’’ (The Tempest).

doi: 10.1016/j.jomh.2008.06.012

Environment and reproduction

A. Giwercman

During the past few decennia the issue of

impairment of male reproductive function

due to environmental toxicants has received

an increasing attention. For testicular germ

cell cancer (TGCC), at least among Caucasians,

a sharp increase in the incidence has been

observed. The magnitude of this increase,

together with other epidemiological data,

as e.g. studies of second generation immi-

grants, clearly indicate a significant impact

of environmental and/or life style related

factors on the aetiology of this malignancy.

It has been suggested that the negative trend

in male reproductive function is not only

limited to the risk of TGCC but also includes

decrease in sperm counts and increase in the

incidence of congenital abnormalities of

male genitalia, cryptorchidism and hypospa-

dias. It has also been suggested that even

testosterone levels are subject to birth cohort

related negative secular trend. However, as

considers these end points the data are not

that unequivocal as those for TGCC. Whereas

the time related trends have been questioned,

clear geographical trends considering male

reproductive function have been found.

The most well investigated are differences

between Finnish and Danish males, the stu-

dies showing higher risk of TGCC, cryptorch-

idism and hypospadias and lower sperm

counts in the latter group. Following the

question arises to which degree these differ-

ences are due to genetic, environmental and/

or life style related factors.

Apart from some few examples of disasters

with release of huge amounts of toxicants

causing reproductive disorders among the

exposed subjects, any clear evidence directly