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1.
Internist (Berl) ; 61(6): 549-557, 2020 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-32377774

RESUMO

Testosterone is a natural hormone which is essential to maintaining physical and emotional wellbeing in men, regardless of age. Male hypogonadism is an endocrine condition of testosterone deficiency with the potential to cause multiple morbidities and psychosocial problems. The condition can be of primary (testicular), secondary (hypothalamic-pituitary) or so-called functional origin (as a result of inflammatory conditions, obesity or chronic illness). Testosterone deficiency can cause symptoms of a sexual nature, foster metabolic dysfunction and impair physical abilities as well as cause osteopenia/osteoporosis and anemia. Testosterone replacement therapy should not be initiated in the case of desired paternity, unclear processes of the prostate or mammary gland and high hematocrit. Diagnosis and treatment as well as monitoring of hypogonadism treatment are clearly regulated by international guidelines and replacement therapy is proven to be effective in ameliorating the above-mentioned symptoms when performed according to these guidelines. In functional hypogonadism, which is most often, but not exclusively, found in older men, treatment of the underlying condition/co-morbidity is mandatory prior to starting testosterone substitution.


Assuntos
Androgênios/uso terapêutico , Terapia de Reposição Hormonal , Hipogonadismo/tratamento farmacológico , Osteoporose/prevenção & controle , Testosterona/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Androgênios/administração & dosagem , Disfunção Erétil/etiologia , Humanos , Hipogonadismo/diagnóstico , Hipogonadismo/etiologia , Masculino , Obesidade , Osteoporose/etiologia , Testosterona/administração & dosagem , Testosterona/efeitos adversos
2.
Zhonghua Xue Ye Xue Za Zhi ; 41(3): 234-238, 2020 Mar 14.
Artigo em Chinês | MEDLINE | ID: mdl-32311894

RESUMO

Objective: To analyze the prognostic factors of transfusion-dependent non-severe aplastic anemia (TD-NSAA) patients treated with cyclosporine A (CsA) and androgen. Methods: Clinical data of 77 consecutive TD-NSAA patients treated with CsA and androgen were retrospectively analyzed between 2010 and 2013. We obtained clinical manifestations and baseline parameters of routine blood test from responders, and compared those with non-responders. All data were analyzed by univariate analysis and multivariate analysis. Results: In 77 patients, there were 43 (55.8%) patients achieved hematological response after 6 months'treatment, and 53 (68.8%) patients got response after 12 months. Univariate analysis showed that platelets baseline was the only factor related to hematological response [19 (6-61) ×10(9)/L vs 13.5 (5-45) ×10(9)/L, P=0.001] after 6 months therapy. After 12 months, the statistical differences were maintained, which were platelets baseline [18 (6-61) ×10(9)/L vs 10.5 (5-45) ×10(9)/L, P<0.001], absolute reticulocytes [0.03 (0.01-0.06) ×10(12)/L vs 0.029 (0.02-0.06) ×10(12)/L, P=0.043], transfusion-dependent of platelet (P=0.007) , transfusion-dependent of platelet and erythrocyte (P=0.012) . Multivariate analysis showed that platelets baseline could be an independent prognostic factor of hematological response (P=0.010 or 0.009) . Cutoff value of platelets by receiver operating characteristic curve was 15.5×10(9)/L. Conclusion: Baseline of higher platelets, higher reticulocyte, and no transfusion dependence of platelet are favorable prognostic factors. When platelets baseline is higher than 15.5×10(9)/L, CsA and androgen regimen is rational.


Assuntos
Androgênios/uso terapêutico , Anemia Aplástica , Ciclosporina/uso terapêutico , Anemia Aplástica/tratamento farmacológico , Soro Antilinfocitário , Combinação de Medicamentos , Humanos , Imunossupressores , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento
6.
Am J Obstet Gynecol ; 222(2): 134-143, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31394072

RESUMO

The field of transgender health continues to expand rapidly, including research in the area of family planning. While much attention has been given to fertility preservation and the parenting intentions of transgender individuals, far less has been paid to pregnancy prevention and contraceptive needs of people along the transmasculine gender spectrum (transgender men and gender-nonbinary persons who were assigned female at birth). Existing research illustrates that many clinicians and transmasculine individuals falsely believe that there is no risk of pregnancy while amenorrheic. These studies also show inconsistent counseling practices provided to transmasculine persons surrounding contraception and pregnancy while falling short of providing robust clinical guidance for improvement. Clinicians report a lack of adequate training in transgender reproductive health, and consequently, many do not feel comfortable treating transgender patients. The aim of this publication is to consolidate the findings of these prior studies and build upon them to offer comprehensive clinical guidance for managing contraception in transmasculine patients. To do so, it reviews the physiologic effects of testosterone on the sex steroid axis and current understanding of why ovulation and pregnancy may still occur while amenorrheic. Gender-inclusive terminology and a suggested script for eliciting a gender-affirming sexual history are offered. Common concerns (such as the effects on gender dysphoria and gender affirmation) and side effects of available contraceptive methods are subsequently addressed and how these may have a unique impact on transmasculine persons as compared with cisgender women. Lastly, a model is provided for approaching contraceptive counseling in the transmasculine population to assist clinicians and patients in determining the need for and selection of the type of contraception. To center transmasculine voices, the development of this publication's guidelines have been led by reproductive care clinicians of transgender experience.


Assuntos
Anticoncepção/métodos , Procedimentos de Readequação Sexual , Pessoas Transgênero , Androgênios/uso terapêutico , Contraceptivos Hormonais , Dispositivos Anticoncepcionais , Feminino , Disforia de Gênero , Humanos , Dispositivos Intrauterinos de Cobre , Masculino , Anamnese , Gravidez , Gravidez não Planejada , Esterilização Reprodutiva , Terminologia como Assunto , Testosterona/uso terapêutico
7.
Curr Diabetes Rev ; 16(3): 189-199, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30073928

RESUMO

BACKGROUND: The current estimated numbers of patients with Type 2 Diabetes (T2D) is believed to be close to 10% of the whole populations of many geographical regions, causing serious concerns over the resulting elevated morbidity and mortality as well as the impact on health care systems around the world. In addition to negatively affecting the quality of life, diabetes is associated with cardiovascular and cerebrovascular complications, indicating that appropriate drug therapy should not only deal with metabolic dysfunction but also protect the vascular system, kidney function and skeletal muscle mass from the effects of the epigenetic changes induced by hyperglycaemia. OBJECTIVE: To provide an insight into the management of hypogonadism associated with T2D, this review focuses on clinical observations related to androgen therapy in qualified diabetic patients, and discusses the lines of evidence for its benefits and risks. The potential interactions of testosterone with medicines used by patients with T2D will also be discussed. CONCLUSION: From recent clinical findings, it became evident that a considerable percentage of patients suffering from T2D manifested low serum testosterone and experienced diminished sexual activity, as well as reduced skeletal muscle mass and lower bone density. Although there are some controversies, Testosterone Replacement Therapy (TRT) for this particular population of patients appears to be beneficial overall only if it is implemented carefully and monitored regularly.


Assuntos
Androgênios/uso terapêutico , Diabetes Mellitus Tipo 2/complicações , Hipogonadismo/tratamento farmacológico , Testosterona/uso terapêutico , Androgênios/efeitos adversos , Androgênios/sangue , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/tratamento farmacológico , Interações Medicamentosas , Terapia de Reposição Hormonal/efeitos adversos , Terapia de Reposição Hormonal/métodos , Humanos , Hipoglicemiantes/uso terapêutico , Hipogonadismo/etiologia , Masculino , Qualidade de Vida , Medição de Risco , Testosterona/efeitos adversos , Testosterona/sangue
8.
Int Immunopharmacol ; 78: 106080, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31855692

RESUMO

Gonadal hormones, estrogen and androgen are strongly involved in the control of the bradykinin production. Estrogen may worsen whereas androgen can be part of the long-term prophylactic treatment. In this review, we will describe the potential impact of estrogen in the pathophysiology of hereditary angioedema (HAE). Then we will review the different hormone treatments and their implication on the course of HAE in women and men: contraception, Assisted Reproductive Technology (ART), menopause, hormone dependent cancers in women and men, treatment of hyperandrogenism in women.


Assuntos
Androgênios/uso terapêutico , Angioedemas Hereditários/tratamento farmacológico , Bradicinina/imunologia , Estrogênios/efeitos adversos , Progestinas/uso terapêutico , Antagonistas de Androgênios/efeitos adversos , Angioedemas Hereditários/diagnóstico , Angioedemas Hereditários/etiologia , Angioedemas Hereditários/prevenção & controle , Bradicinina/metabolismo , Proteína Inibidora do Complemento C1/genética , Proteína Inibidora do Complemento C1/metabolismo , Contraceptivos Hormonais/efeitos adversos , Feminino , Humanos , Hiperandrogenismo/tratamento farmacológico , Hiperandrogenismo/imunologia , Masculino , Menopausa/imunologia , Mutação , Técnicas de Reprodução Assistida/efeitos adversos , Índice de Gravidade de Doença , Fatores Sexuais , Transdução de Sinais/efeitos dos fármacos , Transdução de Sinais/imunologia
9.
Artigo em Inglês | MEDLINE | ID: mdl-31874100

RESUMO

Background Youth population has a common tendency to use androgenic steroids. The reasons for such abuse vary from performance enhancement to muscle building in order to enhance physical appearance. Such rampant abuse, aided by fitness centers and gym trainers, has a huge risk of side effects such as hepatic dysfunctions and increased risk of infections. Case presentation We report a case of 21-year-old man who started with anabolic steroids, namely testosterone enanthate, nandrolone decanoate and boldenone undecylenate injections, for the purpose of muscle building and strength training at his fitness center. He presented to his family physician after 2 months with upper neck swelling on right side 5 × 4 cm for 15-20 days. He was started on Augmentin 625 mg tablet three times a day for 7 days. On seventh day, swelling persisted, and fine needle aspiration cytology (FNAC) was performed, which was suggestive of granulomatous lesion likely to be tuberculosis. The patient was started with anti-tubercular therapy (ATT) under category A, but swelling did not improve and repeated FNAC was advised. The ATT was withheld and Augmentin tablet was restarted for another 3 days. A revised diagnosis of acute suppurative lymphadenitis was made, and an incision and drainage of the abscess was performed. The patient was started on Amikacin 500 intramuscular injection for 5 days along with faropenem and cefuroxime axetil tablets for 14 days. He initially started recovering but returned with pustular discharge from the incision mark. It was decided to reinitiate the ATT-intensive phase medication for another 2 months. The patient finally recovered with complete healing of the wound. The frequent change of treating physician and misuse of antimicrobials made the diagnosis tougher, contributing to delay in the optimum therapy. Conclusion This case highlights the abuse of multiple steroids together in the form of stacking by a young adult, which leads to a rare serious adverse effect such as suspected tubercular reactivation.


Assuntos
Androgênios/uso terapêutico , Congêneres da Testosterona/uso terapêutico , Tuberculose Pulmonar/tratamento farmacológico , Adulto , Humanos , Masculino , Adulto Jovem
10.
Cochrane Database Syst Rev ; 2019(10)2019 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-31684688

RESUMO

BACKGROUND: The final adult height of untreated girls aged up to 18 years with Turner syndrome (TS) is approximately 20 cm shorter compared with healthy females. Treatment with growth hormone (GH) increases the adult height of people with TS. The effects of adding the androgen, oxandrolone, in addition to GH are unclear. Therefore, we conducted this systematic review to investigate the benefits and harms of oxandrolone as an adjuvant therapy for people with TS treated with GH. OBJECTIVES: To assess the effects of oxandrolone on growth hormone-treated girls aged up to 18 years with Turner syndrome. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, the ICTRP Search Portal and ClinicalTrials.gov. The date of the last search was October 2018. We applied no language restrictions. SELECTION CRITERIA: We included randomised controlled clinical trials (RCTs) that enrolled girls aged up to 18 years with TS who were treated with GH and oxandrolone compared with GH only treatment. DATA COLLECTION AND ANALYSIS: Three review authors independently screened titles and abstracts for relevance, selected trials, extracted data and assessed risk of bias. We resolved disagreements by consensus, or by consultation with a fourth review author. We assessed trials for overall certainty of the evidence using the GRADE instrument. MAIN RESULTS: We included six trials with 498 participants with TS, 267 participants were randomised to oxandrolone plus GH treatment and 231 participants were randomised to GH only treatment. The individual trial sample size ranged between 22 and 133 participants. The included trials were conducted in 65 different paediatric endocrinology healthcare facilities including clinics, centres, hospitals and academia in the USA and Europe. The duration of interventions ranged between 3 and 7.6 years. The mean age of participants at start of therapy ranged from 9 to 12 years. Overall, we judged only one trial at low risk of bias in all domains and another trial at high risk of bias in most domains. We downgraded the level of evidence mainly because of imprecision (low number of trials, low number of participants or both). Comparing oxandrolone plus GH with GH only for final adult height showed a mean difference (MD) of 2.7 cm in favour of oxandrolone plus GH treatment (95% confidence interval (CI) 1.3 to 4.1; P < 0.001; 5 trials, 270 participants; moderate-quality evidence). The 95% prediction interval ranged between 0.3 cm and 5.1 cm. For adverse events, we based our main analysis on reliable date from two trials with overall low risk of bias. There was no evidence of a difference between oxandrolone plus GH and GH for adverse events (RR 1.81, 95% CI 0.83 to 3.96; P = 0.14; 2 trials, 170 participants; low-quality evidence). Six out of 86 (18.6%) participants receiving oxandrolone plus GH compared with 8/84 (9.5%) participants receiving GH only reported adverse events, mainly signs of virilisation (e.g. deepening of the voice). One trial each investigated the effects of treatments on speech (voice frequency; 88 participants), cognition (51 participants) and psychological status (106 participants). The overall results for these comparisons were inconclusive (very low-quality evidence). No trial reported on health-related quality of life or all-cause mortality. AUTHORS' CONCLUSIONS: Addition of oxandrolone to the GH therapy led to a modest increase in the final adult height of girls aged up to 18 years with TS. Adverse effects identified included virilising effects such as deepening of the voice, but reporting was inadequate in some trials.


Assuntos
Estatura/efeitos dos fármacos , Hormônio do Crescimento Humano/uso terapêutico , Oxandrolona/uso terapêutico , Síndrome de Turner/tratamento farmacológico , Adolescente , Androgênios/uso terapêutico , Feminino , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Síndrome de Turner/complicações
11.
Drugs Aging ; 36(11): 981-989, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31595418

RESUMO

The number of older adults over 65 years of age is expected to increase to almost 100 million in the US by 2050, more than double the current figure of 46 million. Advanced age is associated with increased frailty among older Americans and often leads to increased disability, hospitalization, institutionalization, and, eventually, mortality. In search of means to improve age-related risks for adverse health outcomes, the question of restoring diminishing sex hormones has gathered much interest and has led to the practice of sex hormone replacement therapies in older men. Recent data suggest that androgen prescription rates in the US for men older than 60 years of age quadrupled from the years 2001 to 2011. While prescription sales of testosterone have increased from $150 million in 2000 to $1.8 billion in 2011, a significant portion of men prescribed testosterone replacement therapy did not meet the laboratory criteria for hypogonadism. While some clinical trials reported an association between testosterone insufficiency in older men and increased risk of death, the exact effects and consequences of testosterone replacement therapy, specifically in older men, remain unclear. This review is aimed at discussing the possible benefits and complications of testosterone replacement therapy in older men over 60 years of age.


Assuntos
Androgênios/uso terapêutico , Terapia de Reposição Hormonal , Hipogonadismo/tratamento farmacológico , Testosterona/uso terapêutico , Idoso , Terapia de Reposição Hormonal/efeitos adversos , Terapia de Reposição Hormonal/métodos , Humanos , Hipogonadismo/metabolismo , Masculino , Pessoa de Meia-Idade , Medição de Risco , Resultado do Tratamento
12.
Thromb Res ; 182: 175-181, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31505312

RESUMO

BACKGROUND: The background for the increased occurrence of thrombosis seen in Klinefelter syndrome (KS) is unknown. The aim was to compare thrombin generation and coagulation inhibition between men with KS and controls, and to investigate whether coagulation in KS was associated with testosterone treatment (TT), and as such, measures of androgen action. METHODS: Untreated men with KS (U-KS) or testosterone treated men with KS (T-KS) were included. KS groups were matched by age and education to groups of control males with no history of TT. Blood samples were collected after overnight fasting. Low tissue factor (1pM) thrombin generation was expressed as lag time (min), time to peak (min), peak (nmol/L), and endogenous thrombin potential (nmol/L × min, ETP). Coagulation inhibitors, sex hormones, and haematocrit were measured. Matched groups were compared by Student's t-test or Wilcoxon rank sum test. Among KS, TT status as an outcome predictor was evaluated by linear regression. RESULTS: 18 U-KS and 27 T-KS with corresponding controls participated. Thrombin generation was not different comparing U-KS and T-KS with respective control groups. Among KS, ETP was lower in T-KS compared with U-KS and inversely associated with testosterone, LH-testosterone ratio and haematocrit. CONCLUSION: Neither U-KS nor T-KS expressed a pro-coagulant state compared with controls. Thrombin generation among KS was inversely associated with androgen action and lower in T-KS compared with U-KS. Whether TT is capable of lowering thrombotic risk among men with KS needs to be assessed prospectively.


Assuntos
Androgênios/uso terapêutico , Coagulação Sanguínea/efeitos dos fármacos , Síndrome de Klinefelter/tratamento farmacológico , Testosterona/uso terapêutico , Trombina/metabolismo , Adolescente , Adulto , Idoso , Androgênios/farmacologia , Estudos Transversais , Humanos , Síndrome de Klinefelter/sangue , Síndrome de Klinefelter/metabolismo , Masculino , Pessoa de Meia-Idade , Testosterona/farmacologia , Trombose/sangue , Trombose/etiologia , Trombose/metabolismo , Adulto Jovem
14.
Curr Diab Rep ; 19(9): 71, 2019 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-31367971

RESUMO

PURPOSE OF REVIEW: Klinefelter syndrome (KS) is associated with increased insulin resistance and high rates of type 2 diabetes (T2DM). Our aim was to review what is known about the prevalence of diabetes in men with KS, potential mechanisms underlying the observed metabolic phenotype, and the data that are available to guide treatment decisions. RECENT FINDINGS: The increased prevalence of T2DM seen in men with KS appears to be the result of multiple mechanisms including increased truncal adiposity and socioeconomic disadvantages, but it is likely not a direct consequence of hypogonadism alone. No randomized trials have been conducted to evaluate the impact of testosterone replacement therapy on T2DM in men with KS, but observational data suggest that testosterone replacement is not associated with lower rates of diabetes or improved glycemic control. Metabolic derangements are common in KS, but treatment strategies specific to this population are lacking. Early lifestyle and dietary interventions are likely important. Additional research is needed to dissect the complex interaction between genotype and metabolic phenotype. Collaboration between academic centers caring for men with KS is needed to facilitate the development of evidence-based clinical practice guidelines, which would inform optimal screening and treatment strategies for this patient population.


Assuntos
Diabetes Mellitus Tipo 2/metabolismo , Síndrome de Klinefelter/metabolismo , Androgênios/uso terapêutico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/etiologia , Terapia de Reposição Hormonal/métodos , Humanos , Resistência à Insulina , Síndrome de Klinefelter/complicações , Masculino , Prevalência , Testosterona/uso terapêutico
15.
Arch Pediatr ; 26(6): 320-323, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31353150

RESUMO

Anorchia, the absence of testes in 46,XY boys, is a very rare condition. It has been suggested that the testicular tissue disappears during pregnancy, as a result of a vascular accident associated with torsion or a genetic cause. Because pubertal growth spurt is directly influenced by androgen exposure, we decided to evaluate the pubertal height gain in nine patients with anorchia who were followed up at the pediatric endocrinology unit of Bicêtre University Hospital. We retrospectively included nine patients with bilateral anorchia whose puberty had been induced by androgen replacement therapy and for whom final height measurements were available. Data were obtained from medical records. Mean gain in pubertal height was 21.7±2.3cm, lower than the expected gain during puberty (25cm, P<0.005). Despite limited experience in this rare condition, androgen replacement therapy seems to allow for good pubertal growth spurt in adolescents with anorchia. However, formal protocols for androgen therapy during puberty may need to be optimized.


Assuntos
Androgênios/uso terapêutico , Estatura/efeitos dos fármacos , Disgenesia Gonadal 46 XY/tratamento farmacológico , Terapia de Reposição Hormonal , Puberdade/fisiologia , Testículo/anormalidades , Testosterona/uso terapêutico , Adolescente , Androgênios/farmacologia , Estudos de Casos e Controles , Criança , Seguimentos , Disgenesia Gonadal 46 XY/fisiopatologia , Humanos , Masculino , Estudos Retrospectivos , Testículo/fisiopatologia , Testosterona/farmacologia , Resultado do Tratamento
16.
Arch Endocrinol Metab ; 63(3): 190-198, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31340240

RESUMO

OBJECTIVE: To summarize current evidence regarding testosterone treatment for women with low sexual desire. MATERIALS AND METHODS: The Female Endocrinology and Andrology Department of the Brazilian Society of Endocrinology and Metabolism invited nine experts to review the physiology of testosterone secretion and the use, misuse, and side effects of exogenous testosterone therapy in women, based on the available literature and guidelines and statements from international societies. RESULTS: Low sexual desire is a common complaint in clinical practice, especially in postmenopausal women, and may negatively interfere with quality of life. Testosterone seems to exert a positive effect on sexual desire in women with sexual dysfunction, despite a small magnitude of effect, a lack of long-term safety data, and insufficient evidence to make a broad recommendation for testosterone therapy. Furthermore, there are currently no testosterone formulations approved for women by the relevant regulatory agencies in the United States, Brazil, and most other countries, and testosterone formulations approved for men are not recommended for use by women. CONCLUSION: Therefore, testosterone therapy might be considered if other strategies fail, but the risks and benefits must be discussed with the patient before prescription. Arch Endocrinol Metab. 2019;63(3):190-8.


Assuntos
Androgênios/uso terapêutico , Libido/efeitos dos fármacos , Disfunções Sexuais Fisiológicas/tratamento farmacológico , Testosterona/uso terapêutico , Adolescente , Adulto , Idoso , Androgênios/efeitos adversos , Androgênios/sangue , Feminino , Humanos , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Sociedades Médicas , Testosterona/efeitos adversos , Testosterona/sangue , Adulto Jovem
17.
Artigo em Inglês | MEDLINE | ID: mdl-30970592

RESUMO

Complete androgen insensitivity syndrome (CAIS) is an X-linked recessive genetic disorder resulting from maternally inherited or de novo mutations involving the androgen receptor gene, situated in the Xq11-q12 region. The diagnosis is based on the presence of female external genitalia in a 46, XY human individual, with normally developed but undescended testes and complete unresponsiveness of target tissues to androgens. Subsequently, pelvic ultrasound or magnetic resonance imaging (MRI) could be helpful in confirming the absence of Mullerian structures, revealing the presence of a blind-ending vagina and identifying testes. CAIS management still represents a unique challenge throughout childhood and adolescence, particularly regarding timing of gonadectomy, type of hormonal therapy, and psychological concerns. Indeed this condition is associated with an increased risk of testicular germ cell tumour (TGCT), although TGCT results less frequently than in other disorders of sex development (DSD). Furthermore, the majority of detected tumoral lesions are non-invasive and with a low probability of progression into aggressive forms. Therefore, histological, epidemiological, and prognostic features of testicular cancer in CAIS allow postponing of the gonadectomy until after pubertal age in order to guarantee the initial spontaneous pubertal development and avoid the necessity of hormonal replacement therapy (HRT) induction. However, HRT is necessary after gonadectomy in order to prevent symptoms of hypoestrogenism and to maintain secondary sexual features. This article presents differential clinical presentations and management in patients with CAIS to emphasize the continued importance of standardizing the clinical and surgical approach to this disorder.


Assuntos
Antagonistas de Androgênios/uso terapêutico , Síndrome de Resistência a Andrógenos/tratamento farmacológico , Síndrome de Resistência a Andrógenos/genética , Androgênios/uso terapêutico , Terapia de Reposição Hormonal/métodos , Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico , Neoplasias Testiculares/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Síndrome de Resistência a Andrógenos/fisiopatologia , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Embrionárias de Células Germinativas/genética , Neoplasias Embrionárias de Células Germinativas/fisiopatologia , Prognóstico , Neoplasias Testiculares/genética , Neoplasias Testiculares/fisiopatologia , Adulto Jovem
18.
Curr Opin Endocrinol Diabetes Obes ; 26(3): 175-179, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30958398

RESUMO

PURPOSE OF REVIEW: The aim of this study is to summarize recently published literature examining androgens and depression. RECENT FINDINGS: The impact of androgen levels, androgen replacement therapy and pharmacologic androgen deprivation on depression and depressive symptoms remain active areas of investigation. Recent publications support the finding that testosterone replacement therapy in men with low testosterone may improve depression, and that androgen deprivation therapy in men with prostate cancer may contribute to depression. SUMMARY: We review the recent literature on androgens and depression and highlight key developments.


Assuntos
Androgênios/sangue , Depressão/sangue , Depressão/etiologia , Antagonistas de Androgênios/uso terapêutico , Androgênios/uso terapêutico , Depressão/epidemiologia , Terapia de Reposição Hormonal/efeitos adversos , Humanos , Masculino , Neoplasias da Próstata/sangue , Neoplasias da Próstata/complicações , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/epidemiologia , Testosterona/uso terapêutico
19.
Sex Med Rev ; 7(3): 476-490, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30803918

RESUMO

INTRODUCTION: Up to 40% of men with type 2 diabetes (T2DM) and metabolic syndrome (MetS) have hypogonadotrophic hypogonadism (HH). Men with HH are at increased risk of cardiovascular (CV) and all-cause mortality, as well as of the development of incident T2DM. AIM: To review the current literature on the metabolic effects of testosterone therapy (TTh) in men with T2DM and MetS. METHODS: We searched MEDLINE, Embase, and Cochrane Reviews for articles on T2DM, HH, testosterone deficiency, and CV and all-cause mortality published between May 2005 and July 2018, yielding 1817 articles, including 54 clinical trials and 32 randomized controlled trials (RCTs). MAIN OUTCOME MEASURES: The main outcomes were glycemic control, insulin resistance, lipid profile, and metabolic markers associated with increased CV risk. RESULTS: RCTs of TTh suggest significant benefits for sexual function, quality of life, glycemic control, insulin sensitivity, anemia, bone density, and fat and lean muscle mass that might be expected to translate into reduced long-term morbidity and mortality. Several longitudinal and observational studies suggest long-term sustained improvements in metabolic parameters and a trend toward reduced CV and all-cause mortality, especially in men at increased CV risk, such as those with T2DM and MetS. The greatest benefit is seen in those men treated with TTh to target levels and for longer durations. CONCLUSION: Meta-analyses of RCTs, rather than providing clarification, may have further confused the issue by including underpowered studies of inadequate duration, multiple therapy regimens, some obsolete or withdrawn, and built-in bias in terms of studies included or excluded from analysis. Hackett G. Metabolic Effects of Testosterone Therapy in Men with Type 2 Diabetes and Metabolic Syndrome. Sex Med Rev 2019;7:476-490.


Assuntos
Glicemia/efeitos dos fármacos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Terapia de Reposição Hormonal/métodos , Hipogonadismo/tratamento farmacológico , Resistência à Insulina , Síndrome Metabólica/tratamento farmacológico , Testosterona/uso terapêutico , Androgênios/uso terapêutico , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Humanos , Hipogonadismo/etiologia , Masculino , Síndrome Metabólica/sangue , Síndrome Metabólica/complicações , Qualidade de Vida , Fatores de Risco
20.
Sex Med Rev ; 7(3): 464-475, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30803919

RESUMO

BACKGROUND: Several data have clearly shown that the endocrine system-and androgens in particular-play a pivotal role in regulating all the steps involved in the male sexual response cycle. Accordingly, testosterone (T) replacement therapy (TRT) represents a cornerstone of pharmacologic management of hypogonadal subjects with erectile dysfunction. AIM: The aim of this review is to summarize all the available evidence supporting the role of T in the regulation of male sexual function and to provide a comprehensive summary regarding the sexual outcomes of TRT in patients complaining of sexual dysfunction. METHODS: A comprehensive PubMed literature search was performed. MAIN OUTCOME MEASURE: Specific analysis of preclinical and clinical evidence on the role of T in regulating male sexual function was performed. In addition, available evidence supporting the role of TRT on several sexual outcomes was separately investigated. RESULTS: T represents an important modulator of male sexual response function. However, the role of T in sexual functioning is less evident in epidemiologic studies because other factors, including organic, relational, and intrapsychic determinants, can orchestrate their effect independently from the state of androgens. Nonetheless, it is clear that TRT can ameliorate several aspects of sexual functioning, including libido, erectile function, and overall sexual satisfaction. Conversely, data on the role of TRT in improving orgasmic function are more conflicting. Finally, further controlled studies are needed to investigate the combination of TRT and PDE5 inhibitors. CONCLUSION: Positive effects of TRT are observed only in the presence of a hypogonadal status (ie, total T < 12 nmol/L). In addition, TRT alone can be effective in restoring only milder forms of erectile dysfunction, whereas the combined therapy with other drugs is required when more severe vascular damage is present. Rastrelli G, Guaraldi F, Reismann Y, et al. Testosterone Replacement Therapy for Sexual Symptoms. Sex Med Rev 2019;7:464-475.


Assuntos
Terapia Comportamental/métodos , Terapia de Reposição Hormonal/métodos , Ereção Peniana/efeitos dos fármacos , Comportamento Sexual , Disfunções Sexuais Fisiológicas/terapia , Testosterona/uso terapêutico , Androgênios/uso terapêutico , Humanos , Masculino , Disfunções Sexuais Fisiológicas/fisiopatologia
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