Implante de testosterona para la mujer, evaluación de seguridad y efectividad en esta vía de administración / Testosterone implant for women, evaluation of safety and effectiveness in this route of administration

INTRODUCCIÓN Y OBJETIVO: El rol de la testosterona exógena en la función sexual femenina ha sido estudiado durante muchos años, con resultados contradictorios. En el último tiempo se ha promovido el uso de pellets de testosterona como una solución para mejorar la libido femenina, la cognición, la fuerza muscular y los sistemas cardiovascular y óseo, e incluso evitar el envejecimiento. Por ello, revisamos las publicaciones para tratar de responder si esto es una moda o el tratamiento más innovador del último tiempo. MÉTODO: Se analizaron las bases de datos PubMed/Medline, Trip Database, Cochrane, SciELO, Scopus, UpToDate, Ovid, ProQuest, Science Direct y ResearchGate. RESULTADOS: De acuerdo con la evidencia, la mejor testosterona disponible es la transdérmica y debe ser usada solo en el trastorno del deseo sexual hipoactivo (TDSH). Los trabajos que evalúan los pellets de testosterona tienen sesgos metodológicos importantes. Si bien son útiles para mejorar la función sexual femenina, producen concentraciones plasmáticas suprafisiológicas de testosterona, por lo que no se puede establecer su seguridad a largo plazo. Tampoco hay datos suficientes que avalen su uso para mejorar el rendimiento cognitivo y el bienestar general, en el tratamiento de enfermedades cardiovasculares o en la prevención de enfermedad ósea. CONCLUSIONES: La testosterona solo se recomienda en el tratamiento del TDSH por vía transdérmica. No recomendamos el uso de pellets de testosterona para el tratamiento de la disfunción sexual ni como hormona antienvejecimiento, ya que no hay estudios consistentes sobre su seguridad, eficacia y efectos adversos a largo plazo.

INTRODUCTION AND OBJECTIVE: The role of exogenous testosterone in female sexual function has been studied for many years with contradictory results. In recent times, the use of testosterone pellets has been promoted as a solution to improve female libido, cognition, muscle strength, cardiovascular system, bone and even prevent aging. Therefore, we will review the publications in order to answer whether this is a fad or the most innovative treatment of recent times. METHOD: The databases PubMed/Medline, Trip Database, Cochrane, SciELO, Scopus, UpToDate, Ovid, ProQuest, Science Direct and ResearchGate were analyzed. RESULTS: So far, the evidence best testosterone available is transdermal testosterone and that it should be used only in hypoactive sexual desire disorder (HSDD). Papers evaluating testosterone pellets have significant methodological biases. While they are useful in improving female sexual function, they produce supra-physiological plasma levels of testosterone, so their long-term safety cannot be established. There is also insufficient data to support their use in improving cognitive performance and general well-being, treatment of cardiovascular disease or prevention of bone disease. CONCLUSIONS: Testosterone is only recommended for the tratment of HSDD via the transdermal route. We do not recommended the use of testosterone pellets for the treatment of sexual dysfunction or as an anti aging hormone, as there are no consistent studies on its safety, efficacy, and long-term adverse effects.

Síndrome metabólico y disfunción eréctil / Metabolic síndrome and erectile dysfunction

OBJETIVO: Puesta al día de un síndrome que en los pasados años ha ido incrementando las patologías coincidentes en el mismo, tales como obesidad, hipertensión, hipercolesterolemia, diabetes tipo II, con la reciente adición de la disfunción erectil y la androgenodeficienciaMÉTODO: Revisión global de la literatura tomando como referencia las últimas aportaciones y muy especialmente las debidas al profesor M. Serrano Ríos, de Madrid, y su grupoRESULTADOS: El síndrome metabólico parece actualmente consolidado como terminó universalmente aceptado, a pesar de su complejo itinerario semántico y nosologico. La inclusión de la disfunción erectil y la androgenodeficiencia le da más solidez patogénica y aproxima más al terreno profesional de la endocrinología a dos procesos prioritariamente urológicos. El urólogo recibe a su vez una nueva perspectiva de procesos que son inexcusablemente propios y a los que ha de atender con mayor amplitud exploratoria, analítica y terapéuticaCONCLUSIÓNES: El síndrome metabólico puede ser reconocido en la consulta urológica con más frecuencia de lo sospechado. El urólogo queda obligado, en este proceso típicamente médico, a ejercer con más dedicación y amplitud el compromiso médico de su especialidad médico quirúrgica(AU)

OBJECTIVES: To update a syndrome that has increased the number of pathologies included such as obesity, hypertension, hypercholesterolemia, type II diabetes mellitus, and the recent addition of erectile dysfunction and androgen deficiencyMETHODS: Global review of bibliography taking the last articles as a reference and mainly those from Prof. M. Serrano Rios and his group in Madrid.RESULTS: Metabolic syndrome seems to be consolidated as a universally accepted term, despite its complex semantic and gnoseologic itinerary. The inclusion of erectile dysfunction and androgen deficiency gives more pathogenic solidity and makes the professional field of endocrinology closer to two mainly urological processes.The urologist has a new perspective of processes that are of his own, that he has to take care of in a comprehensive manner, with physical examination, blood tests and therapy. CONCLUSIONS: Metabolic syndrome may be more frequently than suspected recognized in the urologist office. Urologists are compelled, in this typically medical process, to exercise with more dedication and fullness the medical compromise of our medical-surgical specialty(AU)

Síndrome de insuficiência androgênica: critérios diagnósticos e terapêuticos / Androgen insufficiency syndrome: diagnostic and therapeutic criteria

A síndrome da insuficiência androgênica na mulher (SIA) desperta, mesmo nos dias atuais, muitas discussões e encerra muitas controvérsias. Sabe-se, no entanto, que os níveis plasmáticos de testosterona declinam progressivamente ao longo do período reprodutivo. Conceitua-se a SIA como o conjunto de sintomas clínicos, a presença de biodisponibilidade diminuída de testosterona e os níveis normais de estrogênios. Entre os principais sintomas, citam-se o comprometimento do bem-estar, o humor disfórico, a fadiga sem causa aparente, o comprometimento do desejo sexual, o emagrecimento e a instabilidade vasomotora em mulheres pós-menopáusicas sob terapêutica estrogênica. Esses sintomas, no entanto, são potencialmente atribuíveis a diferentes etiologias e dificultam o correto diagnóstico na maioria dos casos, ainda que ele seja lembrado com freqüência em pacientes que se submetem à ooforectomia bilateral. O diagnóstico da SIA parece ser essencialmente clínico, não havendo a necessidade das dosagens laboratoriais para a sua comprovação. Não se deve indicar a terapêutica androgênica (TA) em pacientes que não estejam adequadamente estrogenizadas. Considera-se a testosterona o hormônio ideal para a TA. As pacientes com sintomas sugestivos de SIA, excluídas outras causas identificáveis, especialmente se pós-menopáusicas, são candidatas à TA. Não existem dados de segurança sobre a TA em usuárias em longo prazo. A via transdérmica - através de adesivos, cremes e gel - parece ser preferível à oral.

The womenÆs androgen insufficiency syndrome (AIS) arises, even nowadays, many debates and clears a lot of controversies. It is known, however, that the plasmatic levels of testosterone gradually decline through the reproductive period. AIS is appraised as a set of clinical symptoms, bioavailability presence diminished of testosterone and normal levels of estrogen. Among the main symptoms that remind the diagnosis are the well-being impairment, dysphoric mood, the fatigue without apparent cause, the sexual desire impairment, the loss of weight and the vasomotor instability in postmenopausal women receiving estrogen. These, however, are potentially attributable to the different etiologies and make it difficult to give the correct diagnosis in the majority of the cases, even though it is reminded, often, in patients who submit to bilateral oophorectomy. The diagnosis of the SIA seems to be essentially clinical, not having the needs of laboratorial dosages for its proof. It shouldnÆt indicate the androgenic therapy (AT) in patients without concomitant estrogen therapy. Testosterone is considered the ideal hormone for AT. Patients with suggestive SIA symptoms, excluded other identifiable causes, especially the post-menopauses ones, are candidates to AT. There are no safety data about AT in long stated period users. The transdermal patches, creams and gel seems to be preferable to the oral formulations.

Hiperandrogenismo: concepto / Hyperandrogenism: concept

El hiperandrogenismo, o exceso de producción de andrógenos en la mujer, puede determinar variadas alteraciones en los tejidos diana donde actúan los andrógenos, condicionando la aparición de hirsutismo, acné, trastornos menstruales o virilización, cuya intensidad y momento de aparición dependerán del origen del exceso de andrógenos y de la edad de la paciente (AU)

Minoxidil tópico na alopecia androgenética: atualizaçäo e experiência pessoal / Topical minoxidil in adrogenetic alopecia: actualization and personal experience

Esse trabalho faz uma atualizaçäo sumária das publicaçöes sobre o minoxidil tópico no tratamento da alopecia androgenética. Säo analisados diferentes aspectos: mecanismo de açäo, metodologia das investigaçöes, promoçäo da resposta de cabelos, diminuiçäo ou cessaçäo da queda de cabelos, eficácia da droga a longo prazo, resultados cosméticos e reaçöes adversas. É relatada a experiência pessoal de um dos autores no tratamento de 44 pacientes com alopecia androgenética, pela soluçäo tópica de minoxidil a 2%. Os resultados näo diferem dos relatados da literatura, evidenciando a eficácia da droga na induçäo do crescimento de cabelos terminais. Entretanto, um efeito cosmético significativo ocorreu em número reduzido de pacientes. Houve ausência de reaçöes adversas, observando-se freqüência pequena de reaçöes locais

Chemical sympathectomy blocks androgen biosynthesis during prepuberty

Twenty-one-day old male Wistar rats were injected subcutaneously with guanethidine (GUA) at doses of 5 and 10 mg kg-1 day-1 for 20 days. Animals were sacrificed by decapitation during the prepubertal (41 days of age) and early-pubertal (51 days of age) periods of sexual development. The tests were collected, frozen in liquid N2 and stored at -70oC until determination of testicular progesterone (P), androstenedione (A) and testosterone (T). Higher levels of P (2.18 +/- 0.24 ng/g, control = 1.24 +/- 0.16 ng/g) associated with decreased with decreased levels of androgens (A = 0.26 +/- 0.06 ng/g T = 2.05 +/- 0.19 ng/g; control = 1.86 +/- 0.76 ng/g and 8.48 +/- 1.16 ng/g, respectively) were observed in 10 mg GUA-treated rats of prebubertal age, while only P levels (3.12 +/- 0.51 ng/g, control = 1.73 +/- 0.27 ng/g) were incresead in rats of early pubertal...

Andrógenos en la mujer menopáusica / Androgens in menopausal women

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Etiological review of hirsutism in 250 patients

Two hundred fifty women with hirsutism were studied, with a mean age of 25.5 years (ranging from 13 to 38 years). The evolution of hirsutism varied from 3 months to 13 years, being minimal in 82 patients (33 per cent), mild in 101 (40 per cent), moderate in 56 (23 per cent) and severe in the remaining 11 women (4 per cent). Polycystic ovary syndrome (PCOS) was diagnosed in 134 patients (53 per cent), overweight or obesity in 45 (18 per cent), late-onset adrenal hyperplasia in five (2 per cent), ovarian tumor in two (0.8 per cent), drug-induced hirsutism and Cushing's syndrome in one patient each (0.4 per cent), and idiopathic hirsutism in 62 cases (25 per cent). Among 67 patients with moderate or severe hirsutism, testosterone was elevated in 21 (31 per cent). In 117 out of 206 (57 per cent) cases polycystic ovaries were observed by ultrasound. Fifty-four patients were treated with a combination of 2 mg cyproterone acetate and 0.035 mg ethinyl estradiol, observing improvement of hirsutism in 32 patients (59 per cent). It is concluded that PCOS is the most frequent cause of hirsutism, but an important proportion of cases without evident etiology remain classified as idiopathic hirsutism