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1.
J Opioid Manag ; 17(2): 135-144, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33890277

RESUMO

OBJECTIVES: The link between male hypogonadism and opioids is well-established, but whether there is a difference in the frequency of hypogonadism between heroin and methadone for treatment of opioid use disorder (OUD) has not been -determined. DESIGN: Cross-sectional. Setting, patients, and participants: Male drug users and nonusers matched for socioeconomic status between 18 and 65 years, recruited in Baltimore as part of the study of HIV, injection drug use, nutrition, and endocrinology (SHINE). METHODS: Hypogonadism was defined as low free testosterone <50 pg/mL. Participants were categorized into three groups based on opioid use: (1) NONE, (2) methadone use as treatment of OUD (METHADONE), and (3) Heroin use (HEROIN). This third group was further divided to mild (MH), and heavy (HH) heroin use. We used multiple logistic regression to examine the association between hypogonadism and different groups. RESULTS: The cohort consisted of 189 men, 94 percent black, average age 43 years, with high HIV (56 percent) and HCV (38 percent) prevalence. 24 percent had hypogonadism. Compared to NONE, there were higher odds of hypogonadism in METHADONE (aOR 3.46; 95 percent CI [1.34,8.93]; p = 0.01) but not in HEROIN. After dividing HEROIN into MH and HH, there were higher odds of hypogonadism in HH compared to NONE (aOR 3.27; 95 percent CI [1.12,9.53]; p = 0.03) but not in MH. CONCLUSIONS: Methadone used for treatment of OUD was associated with male hypogonadism similar to heavy heroin use. Targeted hypogonadism screening and treatment may be warranted in this population to reduce its health consequences such as sexual dysfunction, osteoporosis, and abdominal adiposity.


Assuntos
Analgésicos Opioides , Hipogonadismo , Adulto , Analgésicos Opioides/efeitos adversos , Baltimore/epidemiologia , Estudos Transversais , Humanos , Hipogonadismo/diagnóstico , Hipogonadismo/tratamento farmacológico , Hipogonadismo/epidemiologia , Masculino , Metadona , Tratamento de Substituição de Opiáceos
2.
Front Endocrinol (Lausanne) ; 12: 607179, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33796068

RESUMO

COVID-19 is a complex disease with a multifaceted set of disturbances involving several mechanisms of health and disease in the human body. Sex hormones, estrogen, and testosterone, seem to play a major role in its pathogenesis, development, spread, severity, and mortalities. Examination of factors such as age, gender, ethnic background, genetic prevalence, and existing co-morbidities, may disclose the mechanisms underlying SARS-CoV-2 infection, morbidity, and mortality, paving the way for COVID-19 amelioration and substantial flattening of the infection curve. In this mini-review, we focus on the role of testosterone through a discussion of the intricate mechanisms of disease development and deterioration. Accumulated evidence suggests that there are links between high level (normal male level) as well as low level (age-related hypogonadism) testosterone in disease progression and expansion, supporting its role as a double-edged sword. Unresolved questions point to the essential need for further targeted studies to substantiate these contrasting mechanisms.


Assuntos
/metabolismo , Pandemias , Testosterona/metabolismo , /complicações , Feminino , Humanos , Hipogonadismo/complicações , Hipogonadismo/tratamento farmacológico , Masculino , Testosterona/uso terapêutico
3.
Ter Arkh ; 93(1): 79-83, 2021 Jan 10.
Artigo em Russo | MEDLINE | ID: mdl-33720630

RESUMO

The literature review presents novel data on the prevalence of age-related hypogonadism and its relationship with aging, its impact on the circulatory system and cardiovascular diseases. This review summarizes the methods for diagnosing age-related hypogonadism, its association with traditional cardiovascular risk factors such as dyslipidemia, insulin resistance and diabetes mellitus, obesity, arterial hypertension. The mechanisms of the possible direct effect of testosterone on endothelium and vascular tone, the role of hormone replacement therapy as a way of preventing cardiovascular diseases are discussed.


Assuntos
Doenças Cardiovasculares , Hipogonadismo , Resistência à Insulina , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Terapia de Reposição Hormonal , Humanos , Hipogonadismo/tratamento farmacológico , Hipogonadismo/epidemiologia , Testosterona/uso terapêutico
4.
Ageing Res Rev ; 67: 101301, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33610812

RESUMO

The growing life expectancy in modern societies has raised scientific interest in identifying medical interventions to alleviate age-associated pathologies such as vascular calcification, cognitive decline, sarcopenia, osteoporosis and sexual dysfunction. Although no such single treatment has thus far been established in humans, some clinicians and patients have set their hopes on testosterone replacement therapy (TRT) as a potential "fountain of youth" for aging men. While TRT has proven effective in ameliorating distinct symptoms of late-onset hypogonadism (LOH), its safety remains to be demonstrated. Besides humans, multiple other species exhibit age-related reductions in circulating testosterone levels, raising the question whether such changes are an inherent, pathological feature of growing organismal age or rather reflect an adaptive response. In this manuscript, we apply key principles of evolutionary medicine to testosterone biology and LOH to provide a novel perspective on these two fields. Additionally, we discuss insightful data derived from the animal kingdom to illustrate the plasticity of individual testosterone trajectories across the lifespan, outline cost-benefit-considerations of TRT in LOH and highlight potential caveats of such therapies.


Assuntos
Hipogonadismo , Osteoporose , Adolescente , Envelhecimento , Terapia de Reposição Hormonal/efeitos adversos , Humanos , Hipogonadismo/tratamento farmacológico , Masculino , Testosterona
5.
BMJ Case Rep ; 14(1)2021 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-33509867

RESUMO

A man in his early 60s with a medical history of granulomatosis with polyangiitis (GPA) in remission for two decades without maintenance therapy presented with non-specific complaints of profound fatigue and 40-pound weight loss. He was seronegative for antinuclear antibodies and cytoplasmic antineutrophilic antibodies, but erythrocyte sedimentation rate and C reactive protein levels were elevated. Endocrinological testing revealed adrenal insufficiency, hypogonadism, hypothyroidism and diabetes insipidus. An MRI of the head revealed extensive sinonasal inflammation eroding through the floor of the sella turcica and into the pituitary gland and stalk. Biopsy of the sinonasal tissues was inconclusive. On review of his case, a multidisciplinary team diagnosed him with panhypopituitarism secondary to a recurrence of GPA. He responded well to glucocorticoids and methotrexate with marked reduction of pituitary enhancement on imaging and resolution of diabetes insipidus. He will require lifelong testosterone, levothyroxine and glucocorticoids for hormone replacement therapy.


Assuntos
Insuficiência Adrenal/diagnóstico , Diabetes Insípido/diagnóstico , Granulomatose com Poliangiite/diagnóstico por imagem , Hipogonadismo/diagnóstico , Hipopituitarismo/diagnóstico , Hipotireoidismo/diagnóstico , Rinite/diagnóstico por imagem , Sinusite/diagnóstico por imagem , Insuficiência Adrenal/tratamento farmacológico , Insuficiência Adrenal/etiologia , Androgênios/uso terapêutico , Diabetes Insípido/etiologia , Fadiga/etiologia , Glucocorticoides/uso terapêutico , Granulomatose com Poliangiite/complicações , Granulomatose com Poliangiite/tratamento farmacológico , Granulomatose com Poliangiite/patologia , Terapia de Reposição Hormonal , Humanos , Hipogonadismo/tratamento farmacológico , Hipogonadismo/etiologia , Hipopituitarismo/tratamento farmacológico , Hipopituitarismo/etiologia , Hipotireoidismo/tratamento farmacológico , Hipotireoidismo/etiologia , Imunossupressores/uso terapêutico , Imagem por Ressonância Magnética , Masculino , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Doenças da Hipófise , Hipófise/diagnóstico por imagem , Recidiva , Rinite/patologia , Sela Túrcica/diagnóstico por imagem , Sinusite/patologia , Testosterona/uso terapêutico , Tiroxina/uso terapêutico , Perda de Peso
6.
Am J Clin Oncol ; 44(4): 137-142, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33512910

RESUMO

BACKGROUND: Fatigue is one of the most common adverse events of systemic therapy in patients with metastatic renal cell carcinoma (RCC). The aim of multicenter randomized phase 2 study was to determine the efficacy and safety of testosterone in patients with fatigue developed during targeted therapy. PATIENTS AND METHODS: Male patients with metastatic clear-cell RCC, normal prostate-specific antigen level, low testosterone level, and no evidence of hypothyroidism receiving first-line sunitinib or pazopanib with fatigue were randomly assigned (1:1) to either testosterone undecanoate (1000 mg) and targeted therapy or targeted therapy alone. The primary endpoint was the mean change of fatigue from baseline to 28 days according to the Functional Assessment of Chronic Illness Therapy-Fatigue scale. Secondary endpoints were safety, Functional Assessment of Cancer Therapy-Kidney Symptom Index 19, testosterone serum concentrations, red blood cell count, and hemoglobin level. RESULTS: Sixty patients were assigned to receive testosterone and targeted therapy (N=30) or targeted therapy alone (N=30). As of the data cutoff on December 30, 2019, median follow-up was 18.2 months. The study achieved its primary endpoint based on the significant differences at day 28 favoring testosterone over targeted therapy alone regarding the decreased level of fatigue (difference between groups, 22.5 points; 95% confidence interval, 18.4-26.6; P=0.012). Significant changes in scores demonstrating the enhanced quality of life with testosterone compared with targeted therapy were also observed for Functional Assessment of Cancer Therapy-Kidney Symptom Index 19 disease-related symptoms (P=0.01). There were nonsignificant differences in red blood cell count and hemoglobin level between the 2 groups (all P>0.05). CONCLUSION: Male patients with metastatic RCC and hypogonadism receiving testosterone had less fatigue and better symptom control during targeted therapy.


Assuntos
Carcinoma de Células Renais/secundário , Fadiga/tratamento farmacológico , Neoplasias Renais/tratamento farmacológico , Testosterona/análogos & derivados , Idoso , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/tratamento farmacológico , Fadiga/etiologia , Fadiga/psicologia , Seguimentos , Humanos , Hipogonadismo/complicações , Hipogonadismo/tratamento farmacológico , Neoplasias Renais/complicações , Masculino , Pessoa de Meia-Idade , Pirimidinas/efeitos adversos , Pirimidinas/uso terapêutico , Qualidade de Vida , Sulfonamidas/efeitos adversos , Sulfonamidas/uso terapêutico , Sunitinibe/efeitos adversos , Sunitinibe/uso terapêutico , Testosterona/efeitos adversos , Testosterona/uso terapêutico
8.
J Sex Med ; 18(1): 83-98, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33317996

RESUMO

BACKGROUND: Treatment of "adult-onset hypogonadism" (AOH) with exogenous testosterone therapy (TTh) to raise serum testosterone (T) levels may influence cardiovascular (CV) risk factors in patients with AOH, whereas low endogenous T levels are associated with an increased CV risk and mortality. AIM: To critically evaluate studies reporting increased CV risk associated with TTh and to provide an overview of the risks and benefits of restoring T levels through exogenous TTh. METHODS: A review of publications focusing on the association between TTh and increased CV risk was conducted, and the study methodologies and conclusions of each were critically evaluated. Further, recent clinical and epidemiological studies associating AOH or TTh with a change in CV risk, and pertinent hematologic and vascular effects noted in animal studies and in vitro, as well as in clinical practice were also reviewed. OUTCOMES: A review of the literature shows that untreated testosterone deficiency and/or low T is associated with an increase in CV risk and adverse outcomes, with numerous studies and meta-analyses to support a positive association between exogenous TTh and an improvement in CV risk factors in men with AOH. RESULTS: Numerous studies in the literature demonstrate the positive benefits of using TTh; however, since 2013, some publications have suggested a link to increased CV risk associated with TTh. A number of these studies retrospectively analyzed insurance claims databases using diagnosis codes, procedures codes, and prescription information. Many reviews published since have pointed out the methodological flaws and debatable conclusions of these studies. CLINICAL IMPLICATIONS: A careful assessment of the patient's current health status and CV risk factors should be weighed against the benefits and possible risks resulting from TTh, and consideration should be given to deferring treatment pending resolution or stabilization of CV disease or risk factors. STRENGTHS & LIMITATIONS: In this review, we provide an in-depth analysis of studies reporting increased CV risk with TTh. Many of the studies were not well-designed, randomized, double-blind, prospective clinical trials but rather post hoc analyses of cohort data. These studies may reflect bias in how treatment and nontreatment decisions are made or reflect conclusions based on widely cited methodological flaws. CONCLUSION: Appropriate patient selection supported by low pre-treatment T levels and monitoring T levels during treatment with the goal of achieving and maintaining physiologic levels all contribute to the safe and effective use of TTh in men with AOH. Khera M, Miner M, Jaffe J, et al. Testosterone Therapy and Cardiovascular Risk: A Critical Analysis of Studies Reporting Increased Risk. J Sex med 2021;18:83-98.


Assuntos
Doenças Cardiovasculares , Hipogonadismo , Adulto , Doenças Cardiovasculares/induzido quimicamente , Doenças Cardiovasculares/epidemiologia , Terapia de Reposição Hormonal/efeitos adversos , Humanos , Hipogonadismo/tratamento farmacológico , Masculino , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Fatores de Risco , Testosterona/efeitos adversos
9.
Zhonghua Nan Ke Xue ; 26(3): 237-241, 2020 Mar.
Artigo em Chinês | MEDLINE | ID: mdl-33346963

RESUMO

Objective: To investigate the effect of Jiarong Tablets (JRT) on the testicular morphology and function of rats with late-onset hypogonadism (LOH). METHODS: LOH models were established in 8 eighteen-month-old male SD rats, treated intragastrically with distilled water (the model control group, n = 4) or JRT at 0.375 g/kg/d, qd (the JRT group, n = 4), and another 5 two-month-old normal male SD rats were also given distilled water by gavage (normal control group), all for 28 days. Then all the rats were weighed and sacrificed for measurement of the serum T level and pathological and electron microscopic examination of the testis tissue. RESULTS: Compared with the normal controls, the LOH models showed significantly decreased testis coefficient (P < 0.05) and serum T level (ï¼»3.40 ± 0.06ï¼½ vs ï¼»5.88 ± 0.46ï¼½ ng /ml, P < 0.05). No statistically significant differences were observed in the model control and JRT groups in the body weight and testis coefficient (P > 0.05), but the serum T level (ï¼»4.50 ± 0.78ï¼½ ng/ml) was remarkably decreased in the latter (P < 0.05). In comparison with the model controls, the rats treated with JRT exhibited increases in the sperm count in the seminiferous tubules and the amount of testicular interstitial cells. Electron microscopy revealed a markedly increased number of mitochondria in the JRT-treated animals, with some mitochondrial sheaths and cristae but no obvious mitochondrial edema. CONCLUSIONS: Jiarong Tablets can elevate the serum T level and improve the testicular morphology and ultrastructure of LOH rats.


Assuntos
Medicamentos de Ervas Chinesas , Hipogonadismo , Testículo/efeitos dos fármacos , Animais , Medicamentos de Ervas Chinesas/farmacologia , Hipogonadismo/tratamento farmacológico , Masculino , Ratos , Ratos Sprague-Dawley , Contagem de Espermatozoides , Comprimidos , Testículo/anatomia & histologia , Testosterona/sangue
10.
Zhonghua Nan Ke Xue ; 26(3): 258-264, 2020 Mar.
Artigo em Chinês | MEDLINE | ID: mdl-33346967

RESUMO

Objective: To investigate the effects of Xiongcan Yishen Prescription (XYP) on the expressions of cholesterol transport proteins, steroidogenic enzymes and steroidogenic factor-1 (SF-1) in the Leydig cells of the rats with late-onset hypogonadism (LOH). METHODS: Twenty-five 18-month-old male SD rats were randomly divided into five groups of equal number, LOH model control, testosterone propionate (TP) and low-, medium- and high-dose XYP, and another 5 two-month-old male SD rats included as normal controls. After modeling, the animals in the TP group were treated by intramuscular injection of TP at 5.21 mg/kg qd alt, those in the low-, medium- and high-dose XYP groups intragastrically with XYP at 10.4, 20.8 and 41.6 g/kg qd alt respectively, and those in the LOH model and normal control groups with saline, all for 28 successive days. Then, all the rats were sacrificed for determination of the expressions of the cholesterol transport proteins StAR and TSPO, steroidogenic enzymes CYP11A1, HSD3B7 and HSD17B4, and SF-1 in the Leydig cells by Western blot. RESULTS: The expressions of StAR, TSPO, CYP11A1, HSD3B7, HSD17B4 and SF-1 in the Leydig cells were significantly decreased in the LOH model controls compared with those in the normal controls (P< 0.05), but remarkably increased in the low-, medium- and high-dose XYP groups in comparison with those in the LOH model control group (P< 0.05). CONCLUSIONS: Xiongcan Yishen Prescription can up-regulate the expressions of the cholesterol transport proteins StAR and TSPO, steroidogenic enzymes CYP11A1, HSD3B7 and HSD17B4, and SF-1 in the rat Leydig cells, which might be one of the possible mechanisms of the prescription in the treatment of LOH.


Assuntos
Colesterol/metabolismo , Medicamentos de Ervas Chinesas/uso terapêutico , Hidroxiesteroide Desidrogenases/metabolismo , Hipogonadismo , Células Intersticiais do Testículo/efeitos dos fármacos , Animais , Transporte Biológico , Proteínas de Transporte , Hipogonadismo/tratamento farmacológico , Células Intersticiais do Testículo/metabolismo , Masculino , Fosfoproteínas/metabolismo , Ratos , Ratos Sprague-Dawley , Receptores de Esteroides/metabolismo , Testosterona
11.
Zhonghua Nan Ke Xue ; 26(4): 346-350, 2020 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-33351303

RESUMO

Objective: To evaluate the efficacy and safety of Jiarong Tablets (JRT) combined with Testosterone Undecanoate Capsules (TUC) in the treatment of late-onset hypogonadism (LOH) in males. METHODS: This randomized open multicentered clinical trial included 200 cases of LOH meeting the inclusion, which were equally randomized into a control (aged ï¼»51.09 ± 5.6ï¼½ yr) and a trial group (aged ï¼»50.46 ± 5.2ï¼½ yr) to be treated with oral TUC (40 mg, bid) and TUC+JRT (0.92 g, tid) respectively for 12 successive weeks. We obtained the Aging Males' Symptoms (AMS) and IIEF-5 scores, serum total testosterone (TT) content, red blood cell (RBC) count, hepatic and renal function indexes and glucose and total PSA levels before and after treatment, and compared them between the two groups of patients. RESULTS: Totally, 191 of the LOH patients completed the experiment, 95 in the control and 96 in the trial group. After 12 weeks of treatment, the patients in the trial group, compared with the controls, showed significant improvement in the AMS score (20.6 ± 5.7 vs 31.9 ± 6.1, P < 0.05), IIEF-5 score (20.3 ± 3.1 vs 16.3 ± 3.8, P < 0.05) and serum TT level (ï¼»16.1 ± 3.9ï¼½ vs ï¼»12.7 ± 3.4ï¼½ nmol/L, P < 0.05). There were no significant adverse events or abnormalities in the RBC count, hepatic and renal functions, or glucose and total PSA levels in the two groups of patients before and after medication. CONCLUSIONS: JRT combined with TUC is safe and effective and superior to TUC alone in the treatment of LOH in males.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Hipogonadismo , Testosterona/análogos & derivados , Adulto , Cápsulas , Humanos , Hipogonadismo/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Comprimidos , Testosterona/uso terapêutico , Resultado do Tratamento
12.
Int J Mol Sci ; 22(1)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33375030

RESUMO

Central hypogonadism is a clinical condition, characterized by sexual symptoms and low serum testosterone levels, due to an impaired function of the hypothalamus or pituitary gland. Testosterone replacement therapy (TRT) is the standard treatment for hypogonadism, but it has some disadvantages. TRT is not a good option in men wishing to preserve fertility, nor in men with (a high risk of) prostate cancer, polycythemia, thrombophilia and severe cardiovascular disease. In this review, we discuss alternative treatments for central hypogonadism. If reversible causes are present, non-pharmacological interventions can be therapeutic. Gonadotropins are a good alternative to TRT when fertility is desired in the near future though they require frequent injections. Clomiphene citrate and tamoxifen seem to be a safe alternative for the treatment of functional central hypogonadism in men, as several studies reported a significant increase in testosterone levels with these drugs. However, their use is off-label and data supporting the efficacy of clomiphene citrate and tamoxifen on hypogonadal symptoms are insufficient. For this reason, clomiphene citrate and tamoxifen should not be used in routine clinical practice to treat sexual symptoms in men with central hypogonadism.


Assuntos
Terapia de Reposição Hormonal/métodos , Hipogonadismo/tratamento farmacológico , Testosterona/uso terapêutico , Androgênios/sangue , Androgênios/uso terapêutico , Clomifeno/uso terapêutico , Fertilidade/efeitos dos fármacos , Humanos , Masculino , Moduladores Seletivos de Receptor Estrogênico/uso terapêutico , Testosterona/sangue , Resultado do Tratamento
13.
Eur J Endocrinol ; 183(6): R167-R183, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33105105

RESUMO

Overt hypogonadism in men adversely affects body composition and metabolic health, which generally improve upon testosterone (TS) therapy. As obese men often display lower serum TS levels, in particular when they present with the metabolic syndrome (MetS) or type 2 diabetes (T2DM), there have been claims that androgen therapy prevents or reverses obesity and improves metabolic health. This has contributed to the increase in TS prescriptions during the past two decades. In this narrative review, based on findings from larger observational studies and randomized controlled intervention trials, we evaluate whether low TS predicts or predisposes to obesity and its metabolic consequences, and whether obese men with low TS are truly hypogonadal. We further describe the mechanisms underlying the bi-directional relationships of TS levels with obesity and metabolic health, and finally assess the evidence for TS therapy in men with obesity, MetS and/or T2DM, considering efficacy, safety concerns and possible alternative approaches. It is concluded that low serum sex hormone-binding globulin and total TS levels are highly prevalent in obese men, but that only those with low free TS levels and signs or symptoms of hypogonadism should be considered androgen deficient. These alterations are reversible upon weight loss. Whether low TS is a biomarker rather than a true risk factor for metabolic disturbances remains unclear. Considering the limited number of sound TS therapy trials have shown beneficial effects, the modest amplitude of these effects, and unresolved safety issues, one cannot in the present state-of-the-art advocate TS therapy to prevent or reverse obesity-associated metabolic disturbances. Instead, the focus should remain on lifestyle measures and management of obesity-related consequences.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Terapia de Reposição Hormonal/métodos , Hipogonadismo/tratamento farmacológico , Síndrome Metabólica/tratamento farmacológico , Obesidade/tratamento farmacológico , Testosterona/uso terapêutico , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Humanos , Hipogonadismo/sangue , Hipogonadismo/complicações , Masculino , Síndrome Metabólica/sangue , Síndrome Metabólica/complicações , Obesidade/sangue , Obesidade/complicações , Estudos Observacionais como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Globulina de Ligação a Hormônio Sexual/análise , Testosterona/sangue , Resultado do Tratamento
18.
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
19.
J Urol ; 204(3): 557-563, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32294396

RESUMO

PURPOSE: To evaluate the effect of short-acting 4.5% nasal testosterone gel (Natesto) on serum testosterone, gonadotropins, total motile sperm count, health related quality of life and sexual function. MATERIALS AND METHODS: This was a single institution, open label, single arm trial conducted between November 2017 and September 2019 at the University of Miami. Men 18 to 55 years old diagnosed with symptomatic hypogonadism (total testosterone less than 300 ng/dl on 2 occasions) were included. Men with azoospermia, vasectomy or a total motile sperm count less than 5 million were excluded. Enrolled patients were treated with Natesto, a short-acting nasal testosterone (125 µl per nostril, 11.0 mg testosterone per dose, TID) for 6 months. RESULTS: In total, 60 men were enrolled in the study. Of these, 44 and 33 patients were evaluated for testosterone at 3 and 6 months, respectively. A total of 31 patients (90.9%) reached a normal testosterone level (greater than 300 ng/dl) at 6 months. Follicle stimulating hormone and luteinizing hormone levels were maintained within the normal range in 81.8% and 72.7% of patients at 6 months, respectively. Total motile sperm count was maintained with total motile sperm count greater than 5 million over the treatment period in 88.4% of men at 3 months and 93.9% at 6 months. There were statistically significant improvements on International Index of Erectile Function sexual desire and overall satisfaction domains at 6 months. CONCLUSIONS: Natesto appears to increase testosterone while maintaining semen parameters in a majority of men. Natesto has the potential to be a safe and effective treatment for men with functional hypogonadism who wish to preserve semen parameters. Long-term studies beyond 6 months are needed before we can safely prescribe nasal testosterone gel for men interested in fertility.


Assuntos
Hipogonadismo/tratamento farmacológico , Testosterona/administração & dosagem , Administração Intranasal , Adolescente , Adulto , Biomarcadores/sangue , Géis , Gonadotropinas/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Contagem de Espermatozoides , Testosterona/sangue
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