Age androgen deficiency

Testosterone levels can decrease with age by about 1% per year in both men and women after a certain age; this phenomenon is well documented; The reasons for the decline are not entirely clear. ^{[1] [2] [3] [4] [5]}

Epidemiology is not clear; 20% of men aged 60 and 30% of men aged 70 have low testosterone levels; ^{[2] [6]} About 5% of men aged 70 to 79 years have low testosterone levels and symptoms, so they are diagnosed with age-related hypogonadism. ^{[2] The} National Health Service describes the disease as rare. ^[7]

When a diagnosis is established, both the presence of a clinical picture and a laboratory-confirmed low testosterone level are taken into account.

The clinical manifestations of low testosterone include:

• Sexual dysfunction
  • Erectile dysfunction
  • Decreased sex drive (libido)
  • Orgasm Disorders
  • Violation of ejaculation (ejaculation)
  • Reduced fertility (fertilization capacity)
• Somatic disorders
  • Increased adipose tissue
  • Urination disorders (weak stream, night urge, frequent urination)
  • Decreased muscle strength and muscle mass
  • Decreased bone density, lower back pain and joint pain
  • Physical exhaustion, decay of vitality
• Emotional disorders
  • Decreased performance
  • Increased fatigue, increased need for sleep
  • Sleep problems (difficulty falling asleep, during sleep, early awakening, insomnia)
  • Decreased memory and attention
  • Irritability (sensations of aggressiveness, irritation over trifles, despondency)
  • Nervousness (internal stress, fussiness, anxiety), anxiety, depression

In laboratory diagnosis, the determination of testosterone is of primary importance. The diagnosis of age-specific androgen deficiency is established when total testosterone levels fall below 8 nmol / l (excluding thyroid pathology and hyperprolactinemia). Level 8-12 nmol / l (230-345 ng / dL) is considered to be marginal and requires the calculation of free testosterone based on GSPG data. and blood albumin. With a normal level of free testosterone, there is no androgen deficiency. In addition, in the diagnosis of age-related androgen deficiency, sex steroids (GSPS), gonadotropins: follicle-stimulating (FSH) and luteinizing hormone (LH), estrogens: estradiol (E2), and prolactin are important.

When making a diagnosis of age androgen deficiency, it is important to exclude the presence of another endocrine pathology (dysfunction of the thyroid gland, aromatase activity in excess adipose tissue, hyperprolactinemia).

Treatment of age-related androgen deficiency consists in lifelong administration of drugs that increase testosterone levels in the blood, which leads to a loss of the ability to produce endogenous testosterone by suppressing the production of gonadotropins in the hypothalamic-pituitary system. Testosterone treatment is aimed only at eliminating its deficiency in the body, but not for treatment impaired spermatogenesis. Conversely, the appointment of testosterone in such cases only exacerbates the violation of spermatogenesis, because inhibits gonadotropin secretion. If it is important for the patient to preserve fertility, then it is necessary to choose another method of treatment besides testosterone. Adverse effects of testosterone treatment include effects on the prostate, sleep apnea, erythrocytosis, venous thromboembolism and the risk of cardiovascular diseases. Another more modern approach to the treatment of androgenic deficiency is anti-estrogen and aromatase inhibitors from sports medicine, allowing for increased production of gonadotropins and The result is an increased level of endogenous testosterone production. ^[8] Currently, this approach to treatment has obvious advantages over hormone replacement therapy with testosterone drugs.

The problem of age-related androgenic deficiency in older men is not limited to only sexual and psychoemotional disorders, but also has an impact on many organs and systems of the body, and therefore the importance of detecting androgen deficiency cannot be underestimated and its treatment.

Since all currently used drugs have their advantages and disadvantages, treatment aimed at normalizing the level of testosterone in the body should be prescribed by a competent specialist, taking into account its effectiveness, tolerability and convenience for the patient.

• Menopause

Male menopause