El deseo sexual en varones adultos mayores, su relación con la testosterona sérica y otros factores / Sexual desire in older men and its association with serum testosterone and other factors

Introducción: el deseo sexual cambia con el envejecimiento, la verdadera magnitud de estos cambios y los factores que los condicionan son aún objeto de debate. Objetivo: describir las características del deseo sexual en varones adultos mayores del municipio Plaza de la Revolución y su asociación con la testosterona sérica y otras variables. Métodos: estudio transversal descriptivo, con base poblacional. Participaron 510 varones de 60 años y más, sin limitaciones físicas o cognitivas, ni condiciones que causan hipogonadismo, seleccionados mediante muestreo estratificado polietápico complejo entre los residentes del municipio Plaza de la Revolución, en La Habana. Contestaron cuestionario anónimo autoadministrado, se recogieron datos del interrogatorio y examen físico, y se determinó testosterona sérica total. Se evaluaron aspectos del deseo sexual y factores con posible influencia sobre este; se analizaron estadísticas descriptivas y pruebas de chi cuadrado, Kruskal Wallis y regresión logística múltiple. Se cuidaron aspectos éticos. Resultados: la edad de los participantes fue entre 60 y 93 años (mediana 70). El 82,41 por ciento refirió cambios en su deseo sexual en relación con edades previas; de estos, 79,16 por ciento señaló disminución, 11,66 por ciento pérdida y 9,18 por ciento aumento. El 55,02 por ciento dijo tener nivel de deseo sexual medio, 44,53 por ciento lo experimentaban a menudo, y 4,25 por ciento nunca. El 71,22 por ciento refirió estar satisfechos o medianamente satisfechos con su deseo sexual. No se observó relación entre la testosterona sérica y los cambios en el deseo sexual, nivel o frecuencia actual (p> 0,05). La disminución del deseo sexual mostró asociación positiva significativa con la edad mayor a 80 años, disminución de la sensación de bienestar y consumo de medicamentos; y asociación negativa, con la actitud hacia la sexualidad (p< 0,05). La escolaridad, la ocupación, las creencias religiosas, el estado civil, el tiempo de relación de pareja, las enfermedades cónicas, los hábitos tóxicos, los ejercicios físicos, la socialización, el estado psicológico, la educación sexual, la importancia que le conceden a la sexualidad, o tener privacidad, no se relacionaron significativamente con la disminución del deseo sexual. Conclusiones: el deseo sexual cambia con la edad, predominantemente en sentido de disminución, pero la mayoría de los sujetos se sienten satisfechos o medianamente satisfechos, lo experimentan a menudo y en un nivel medio. La disminución del deseo sexual en los sujetos estudiados no depende de la testosterona sérica, y sí de otros factores biológicos, psicológicos y sociales(AU)

Introduction: sexual desire decreases with aging but the real scope of these changes and the factors unleashing them are still a topic under debate. Objective: to describe the characteristics of the sexual desire in older men from Plaza de la Revolution municipality and their association with serum testosterone and other variables. Methods: population-based descriptive and cross-sectional study which involved 510 men aged 60 years and older, who did not present either physical/cognitive handicaps or conditions leading to hipogonadism. They had been selected from the residents of Plaza de la Revolucion municipality in Havana through a complex multistage stratified sampling. They answered a self-administered anonymous questionnaire; their questioning and physical exam data were then collected and the total serum testosterone was determined. Several sexual desire aspects together with the possible influential factors were evaluated; the summary statistics in addition to Chi-square, Kruskall-Wallis's and multiple logistic regression tests were all analyzed. Moreover, ethical aspects were respected. Results: the age of the participants ranged 60 to 93 years (median of 70). In this group, 82.41 percent pointed out that their sexual desire had changed in comparison with earlier ages and from this percentage, 79.16 percent said their desire decreased, 11.66 percent stated it had disappeared whereas in 9.18 percent it had increased. The answers showed that the degree of sexual desire was medium in 55.02 percent of participants, 44.53 percent often felt it whereas 4.25 percent never had it. In the study group, 71.22 percent were satisfied or fairly satisfied with their degree of sexual desire. There was no association between the serum testosterone and the changes in the current degree and frequency of sexual desire (p> 0.05). The decrease in sexual desire showed significant positive association with the age older than 80 years, less sensation of wellbeing and lower consumption of drugs; however, it was negatively associated to the attitude towards sexuality (p< 0.05). Schooling, occupation, religious beliefs, marital status, length of time of a couple relationship, chronic diseases, toxic habits, physical exercising, socialization, psychological condition, sexual education, importance attached to sexuality or to privacy were not significantly associated with decrease of sexual desire. Conclusions: sexual desire changes with the age, particularly towards decrease, but the majority of older men are satisfied or fairly satisfied with it; they often feel it with medium degree. The decreased sexual desire in the studied subjects does not depend on the serum testosterone but it does on other biological, psychological and social factors(AU)

Asociación entre niveles de testosterona, sensibilidad a la insulina, adiposidad y parámetros lipídicos en hombres / Association between testosterone levels, insulin sensitivity, adiposity and lipid parameters in men

Introducción: Evidencias sugieren que la testosterona interviene en la regulación del metabolismo de la glucosa y los lípidos.Objetivo: determinar la relación entre los niveles de testosterona y la sensibilidad a la insulina, la adiposidad y los parámetros del metabolismo lipídico en hombres.Métodos: estudio transversal y descriptivo en 225 hombres, entre 35 y 60 años, con y sin trastornos de la tolerancia a la glucosa. Se midieron: talla, peso, circunferencias de la cintura y de la cadera. Se realizaron determinaciones de insulina, glicemia, testosterona, colesterol, HDL-colesterol, LDL-colesterol y triglicéridos. Se determinaron índices de sensibilidad y resistencia a la insulina.Resultados: se encontró una correlación negativa entre los niveles de testosterona y la resistencia a la insulina, y los parámetros de adiposidad explorados (índice de masa corporal, circunferencias abdominal y de la cadera, índice cintura/cadera). El nivel de testosterona fue menor en los sujetos con hipertrigliceridemia. En los sujetos con trastornos de la tolerancia, se encontró un aumento significativo de la frecuencia de obesidad abdominal en presencia de valores bajos de testosterona.Conclusiones: existe una asociación directa entre los niveles de testosterona y la sensibilidad a la insulina en la población estudiada. La disminución de los niveles de testosterona en presencia de los desórdenes asociados al síndrome metabólico, sugiere la indicación de una evaluación metabólica temprana a los pacientes con hipogonadismo(AU)

Introduction: Evidence suggests that testosterone participates in the regulation of glucose and lipid metabolism.Objective: determine the relationship between testosterone levels and insulin sensitivity, adiposity and metabolism parameters in men.Methods: a descriptive cross-sectional study was conducted of 225 men aged 35-60 with and without glucose tolerance disorders. The variables measured were height, weight, and waist and hip circumference. Determinations were made for insulin, glycemia, testosterone, cholesterol, HDL cholesterol, LDL cholesterol and triglycerides. Insulin sensitivity and resistance were also determined.Results: a negative correlation was found between testosterone levels/insulin resistance and the adiposity parameters considered (body mass index, waist and hip circumference and waist to hip ratio). Testosterone levels were lower in subjects with hypertriglyceridemia. Patients with tolerance disorders showed a significant increase in the frequency of abdominal obesity in the presence of low testosterone values.Conclusions: a direct relationship was found between testosterone levels and insulin sensitivity in the population studied. Reduced testosterone levels in the presence of disorders associated to metabolic syndrome suggest the need for an early metabolic assessment of patients with hypogonadism(AU)

Clinical Practice Guidance for the Use Of Clomiphene Citrate in Male Hormone Replacement Therapy (HRT).

Introduction: Inhibition of pituitary gonadotropin secretion in men by testosterone (T) is principally mediated by aromatization to estrogen (E), which inhibits hypothalamic secretion of gonadotropin-releasing hormone (GnRH). Material and Methods: Longitudinal clinical investigation unit-based evaluation of the clinical and biochemical response to E-receptor blockade. Initial monotherapy with 50 mg of clomiphene citrate (CC) daily for a period of 9 months, with diurnal morning peak testosterone and luteinizing hormone (LH) levels evaluated at three-month intervals thereafter. Th e patient then resumed hormone replacement therapy (HRT) using T cream with adjuvant CC therapy. Main Outcome Measures were Baseline and stimulated T and LH levels; eff ect on sexual function. Result(S): CC therapy resulted in complete normalization of pulsatile gonadotropin secretion, serum T level, and sexual function. Conclusion(S): Isolated hypogonadotropic hypogonadism (IHH) may result from an acquired defect of enhanced hypothalamic sensitivity to E-mediated negative feedback. Whereas direct T replacement therapy can further suppress endogenous gonadotropin secretion, treating IHH men with gonadotropins can stimulate endogenous T secretion and enhance fertility potential. Reversal of gonadotropin defi ciency with CC was found to have a similar biological eff ect.

Relationship between insulin and hypogonadism in men with metabolic syndrome / Relação entre insulina e hipogonadismo em homens com síndrome metabólica

OBJECTIVE: To evaluate the incidence of hypogonadism in men with metabolic syndrome and its correlation with serum insulin levels. METHODS: Observational, transversal study with 80 men with metabolic syndrome. The individuals were divided into two groups: Group 1: 56 patients (70 percent) with total testosterone > 300 ng/dL (normal gonadal function); Group 2: 24 patients (30 percent) with total testosterone < 300 ng/dL (hypogonadic). RESULTS: The subjects from Group 2 compared to Group 1 presented higher body mass index (BMI), waist and hip circumferences, insulin, homeostasis model assessment insulin resistance index (Homa-IR) and beta cell (Homa-β), and triglycerides, but lower SHBG and free testosterone values. Inverse correlations between insulin levels and total testosterone and SHBG, as well as between Homa-IR and total testosterone were observed. CONCLUSION: In this series of men with metabolic syndrome, hypogonadism was associated with insulin resistance and may be a marker of metabolic abnormalities.

OBJETIVO: Avaliar a frequência de hipogonadismo em homens portadores da síndrome metabólica e a sua correlação com a concentração sérica de insulina. MÉTODOS: Estudo observacional e transversal com 80 homens portadores da síndrome metabólica. Os sujeitos foram estratificados em dois grupos: Grupo 1: 56 pacientes (70 por cento) com testosterona total > 300 ng/dL (função gonadal normal); Grupo 2: 24 pacientes (30 por cento) com testosterona < 300 ng/dL (hipogonádicos). RESULTADOS: Os sujeitos do Grupo 2 comparados ao Grupo 1 tinham maior índice de massa corporal (IMC), de circunferências do quadril e da cintura, insulina, Homa-IR, Homa-β e triglicerídeos, mas tinham valores menores de SHBG e testosterona livre. Observou-se correlação inversa da concentração de insulina com a de testosterona total e SHBG, e do Homa-IR com a concentração de testosterona total. CONCLUSÃO: Nos indivíduos estudados, a presença de hipogonadismo esteve associada à resistência à insulina, podendo ser um marcador de alterações metabólicas.

Andropause in Indian men: a preliminary cross-sectional study

The purpose of this study was to determine the frequency of androgen decline in the aging male [ADAM] in a group of Indian men working in the health sector. A free medical health checkup camp was organized for the male workers aged between 40 and 60 years employed in surgical departments of our hospital. Of 180 listed male workers, 170 attended this camp 157 eligible men participated in the study. After clinical history and systemic inquiry, the participants were requested to complete the Saint Louis University's ADAM questionnaire, and their serum levels of free and total testosterone were measured. Symptomatic andropause was found in 106 men [67.5%] on the basis of their responses to the questionnaire, of whom 41 [38.7%] had low serum free testosterone levels and 32 [30.2%] had low serum levels of total testosterone. Fifty-one men were asymptomatic according to the questionnaire and in this group, 11 [21.6%] had low serum free testosterone levels and 6 [11.8%] of these had low total testosterone levels. The frequency of andropause was 33.1% on the basis of low serum free testosterone levels and it was 26.1% when both symptoms and low serum free testosterone levels were taken into account. In our study, the high frequency of symptoms related to ADAM was unusual. This might be due to the nature of the questionnaire itself. Serum free testosterone measurement may be a better single test for diagnosis of hypogonadism than serum total testosterone measurement

Risk of late-onset hypogonadism (andropause) in Brazilian men over 50 years of age with osteoporosis: usefulness of screening questionnaires / Risco relativo de hipogonadismo tardio (andropausa) em brasileiros com mais de 50 anos com osteoporose e a utilidade de questionários de triagem

OBJECTIVE: To analyze the relative risk of late-onset hypogonadism in men with osteoporosis and the usefulness of screening questionnaires. METHODS: We correlated the Aging Male's Symptoms (AMS), Androgen Deficiency in Aging Male (ADAM) and International Index of Erectile Function (IIEF-5) questionnaires and the laboratory diagnosis of hypogonadism in 216 men aged 50-84 years (110 with osteoporosis and 106 with normal bone density, paired by age and ethnicity). RESULTS: Hypogonadism presented in 25 percent of the osteoporotic and in 12.2 percent of normal bone density men (OR 2.08; IC95 percent: 1.14-3.79) and was associated with ADAM first question (low libido, p=0.013). Levels of TT below 400 ng/dl correlated with an AMS score above 26 (p=0.0278). IIEF-5 showed no correlation with testosterone levels. CONCLUSION: Hypogonadism was 2.08 times more prevalent in osteoporotic men. The symptom that best correlated with late-onset hypogonadism was low libido (ADAM 1 positive).

OBJETIVOS: Avaliar o risco relativo de hipogonadismo tardio em homens com osteoporose e a utilidade de questionários de triagem. MÉTODOS: Correlacionamos a pontuação dos questionários Aging Male's Symptoms (AMS), Androgen Deficiency of the Aging Male (ADAM) e International Index of Erectile Function (IIEF-5) com dosagens de testosteronas em 216 homens entre 50 e 84 anos (110 com osteoporose e 106 com densidade óssea normal, pareados por idade e etnia). RESULTADOS: Hipogonadismo ocorreu em 25 por cento dos osteoporóticos e em 12,2 por cento dos com densidade óssea normal (RR 2,08; IC95 por cento: 1,143,79) e esteve associado à pergunta 1 do ADAM (diminuição de libido, p = 0,013). Testosterona total < 400 ng/dL associou-se a AMS > 26 (p = 0,0278). Disfunção erétil, avaliada pelo IIEF-5, não se correlacionou com dosagens de testosteronas. CONCLUSÃO: Hipogonadismo foi 2,08 vezes mais prevalente em homens com osteoporose e esteve associado à diminuição da libido (ADAM 1 positivo).

Comparación de distintos métodos para evaluar la función androgénica en el adulto mayor / Assessment of androgenic decline in the elderly

Background:The gold standard to assess androgenic status is the measurement of free testosterone by equilibrium dialysis. However, the estimation of free testosterone using formulas based on the law of mass action can be an adequate standard. Aim: To assess androgenic decline in the elderly by different methods. Material and methods: Free testosterone by radioimmunoassay, total testosterone and steroid binding globulin (SHBG) by automated chemiluminiscence system and estradiol by automated electrochemiluminiscence system were measured in 30 male aged 64±5 years (range 60-70), and 25 males aged between 20 and 30 years, as control group; devoid of diseases or drugs that could cause hypogonadism. Free androgen index, free testosterone, biavailable testosterone, and free estradiol were calculated using a formula based on the law of mass action. Results: Fifty seven percent of elderly subjects had hypogonadism, according to calculated free testosterone values. Their total testosterone was on average, 152 nd/dl lower than in young adults, figure that represents a 3.8 ng/dl decline per year. According to total testosterone values, 27 percent of elderly males had gonadal incompetence. The correlations between calculated free testosterone and total testosterone was 0,95 and between calculated free testosterone and measured free testosterone was 0,67. The methods employed overestimated (76.7 percent of hypogonadism when using the free androgen index) or underestimated (27 and 3 percent of hypogonadism, considering total or free testosterone, respectively) the ondrogen decline of the elderly. Among the elderly, 16 or 30 percent of subjects had an absolute hypoestrogenism, based on estradiol or calculated free estradiol values, respectively. On average there was a 20 and 30 percent reduction of estradiol and calculated free estradiol values in the elderly. Conclusions: Calculated free or bioavailable testosterone values should be used to assess androgen decline in elderly men.

Hipogonadismo asociado a la senilidad en el varon (climaterio masculino - andropausia - Adam) / hypogonadism associated to male senescense (male climateric -andropause - ADAM

Actualmente se acepta que en hombres envejecidos sanos existe un descenso progresivo aunque no universal, de la testosterona total y libre, llegando un 20 a 30 por ciento a rango hipogonádico. El diagnóstico de hipogonadismo asociado a envejecimiento es de exclusión. Se requieren estudios para poder diferenciar si los síntomas compatibles con hipogonadismo se deben a falla testosterónica, envejecimiento o alteración de otros ejes endocrinos.

Hipogonadismo Masculino: Un Enfoque Sencillo y Práctico / Male Hipogonadism: A Simple and Practical Approach

El hipogonadismo masculino representa una diminución de la función testicular con una baja en la producción de testosterona e infertilidad. Puede ser ocasionado por un problema intrínseco de los testículos (hipogonadismo primario), una falla del eje hipotálamo-hipofisiario (hipogonadismo secundario) o una respuesta disminuída o ausente de los órganos blanco a los andrógenos (resistencia androgénica). Los síntomas del hipogonadismo incluyen la caída del vello corporal, disminución de la función sexual y cambios de la voz. Dependiendo de la edad de aparición puede presentarse atrofia testicular, hábito eunocoide y ginecomastia. A largo plazo puede presentarse osteoporosis. El diagnóstico se sospecha clínicamente y se establece con la demostración de concentraciones bajas de testosterona sanguínea. Si existe un aumento concomitante de las gonadotropinas circulantes, Hormona Folículo Estimulante y Hormona Luteinizante, se habla de un hipogonadismo primario; pero si ambas están disminuidas el hipogonadismo es secundario. Existen diferentes formas de testosterona para el tratamiento de los pacientes con hipogonadismo; la más común, es la testosterona de depósito (enantato o cipionato) la cual se inyecta por vía intramuscular. La terapia actual consiste en la administración de testosterona por vía transdérmica, no escrotal, obteniéndose una concentración normal de testosterona con preservación del ritmo cardíaco