Late-onset hypogonadism in males: Guidelines and controversies / 中华内分泌代谢杂志

Late-onset hypogonadism (LOH) is an age-related testosterone deficiency syndrome. With the increasing aging of society, LOH results in impaired quality of life of middle-aged and elderly men. Although domestic and international guidelines have been issued in recent years, and the management of LOH became more standardized, numerous controversies still remained in the diagnosis of LOH, the benefits of testosterone replacement therapy (TRT) and therapeutic targets. Based on comparison of different guidelines, this review focuses on age cut-off , specific signs and symptoms of LOH, diagnostic cut-off level of testosterone, the advantages and disadvantages of TRT treatment, and non-testosterone therapy.

Prevalence of late-onset hypogonadism among middle-aged and elderly males in China: results from a national survey / 亚洲男科学杂志(英文版)

This study aimed to propose an operational definition of late-onset hypogonadism (LOH) that incorporates both clinical symptoms and serum testosterone measurements to evaluate the prevalence of LOH in aging males in China. A population-based sample of 6296 men aged 40 years-79 years old was enrolled from six representative provinces in China. Serum total testosterone (TT), sex hormone-binding globulin (SHBG), and luteinizing hormone (LH) were measured and free testosterone (cFT) was calculated. The Aging Males' Symptoms (AMS) scale was used to evaluate the LOH symptoms. Finally, 5078 men were included in this analysis. The TT levels did not decrease with age (P = 0.59), and had no relationship with AMS symptoms (P = 0.87 for AMS total score, P = 0.74 for ≥ 3 sexual symptoms). The cFT levels decreased significantly with age (P < 0.01) and showed a negative association with the presence of ≥ 3 sexual symptoms (P = 0.03). The overall estimated prevalence of LOH was 7.8% (395/5078) if a cFT level <210 pmol l

Tratamiento con testosterona en el hipogonadismo de inicio tardío / Late-Onset Hypogonadism Treatment with Testosterone

RESUMEN Introducción: El uso de la terapia de reemplazo con testosterona en hombres mayores se ha incrementado en los últimos años, lo que ha generado múltiples controversias aún no resueltas acerca de sus beneficios y riesgos potenciales, sobre todo los relacionados con el desarrollo o agravamiento de la enfermedad prostática o cardiovascular. Métodos: Se realizó una revisión bibliográfica con el objetivo de ofrecer un estado de la cuestión que ayude a los médicos a tomar decisiones al considerar el tratamiento con testosterona en pacientes con hipogonadismo de inicio tardío. La búsqueda de información se realizó en las bases de datos Google Académico, Medline y Pubmed. Conclusiones: El tratamiento con testosterona en el hipogonadismo de inicio tardío es seguro, racional y basado en evidencia, pero no se recomienda ofrecerlo a todos los hombres mayores con niveles bajos de testosterona sérica. Se aconseja en aquellos con síntomas manifiestos de deficiencia androgénica, sin cáncer de próstata activo, de mama o hígado, hematocrito elevado, hiperplasia prostática benigna con síntomas obstructivos graves, nódulo o induración prostática no evaluada, antígeno prostático específico > 4 ng/mL (o > 3 ng/mL en pacientes con alto riesgo), apnea obstructiva del sueño severa no tratada, deseos de fertilidad a corto plazo, insuficiencia cardiaca no controlada, infarto agudo de miocardio o accidente cerebrovascular en los últimos SEIS meses o trombofilia. Se recomienda realizar monitoreo trimestral durante el primer año y luego según cada caso, que incluya evaluación de la respuesta clínica, de condiciones que pueden agravarse con el tratamiento y de parámetros de laboratorio(AU)

ABSTRACT Introduction: The use of testosterone replacement therapy in older men has increased in recent years, which has generated multiple controversies not yet resolved about its benefits and potential risks, especially those related to the development or worsening of the prostate or cardiovascular disease. Methods: A literature review was conducted with the aim of offering a state of the art that helps clinicians make decisions when considering testosterone treatment in patients with late-onset hypogonadism. The information search was carried out with the Google Scholar, Medline and Pubmed search engines. Conclusions: Testosterone treatment in late-onset hypogonadism is safe, rational, and evidence-based, but it is not recommended to offer it to all older men with low serum testosterone levels. It is advised in those with overt symptoms of androgen deficiency, without active prostate, breast or liver cancer, elevated hematocrit, benign prostatic hyperplasia with severe obstructive symptoms, untested prostate nodule or induration, prostate specific antigen > 4 ng / mL (or > 3 ng / mL in high-risk patients), severe untreated obstructive sleep apnea, short-term fertility wishes, uncontrolled heart failure, acute myocardial infarction or stroke in the last SIX months, or thrombophilia. It is recommended to carry out quarterly monitoring during the first year and then according to each case, which includes evaluation of the clinical response, of conditions that can be aggravated by treatment, and of laboratory parameters(AU)

Current Situation and Reconsideration on the Study of Integrated Chinese and Western Medicine Andrology / 中国结合医学杂志

The development of Chinese medicine and Western medicine andrology is based on different social background and academic systems, either Chinese medicine or Western medicine andrology has their limitations, therefore, integration of Chinese and Western medicine (ICWM) andrology is in a great need. After more than 30 years of development, andrology has made great achievements in the construction of specialized academic association, holding academic conferences and publication of academic monographs, and the research progress on this field is mainly in the combination of disease and syndrome, microdifferentiation of symptoms and signs and basic research development. However, the comprehensive theoretic system of ICWM andrology has not yet established, and the related studies are still on the primary stage. In the future studies, great efforts still need to be made to expand the methods for the investigation of ICWM, and make innovations in the field of andrology.

The dilemma of testosterone supplementation therapy for male testosterone deficiency and its possible causes / 中华内分泌代谢杂志

Due to prolonged life expectancy, people's requirements for quality of life are also increasing. As a protein anabolic hormone, testosterone not only improves muscle and bone health, but also improves energy and sexual function. It is widely used in middle-aged and elderly people, especially in patients with delayed-onset hypogonadism( LOH). However, as several clinical studies have found that testosterone supplementation increases cardiovascular risk, the use of testosterone decreased sharply, and some patients who require testosterone therapy thus do not receive treatment timely. This article summarizes the current clinical research results and analyzes the dilemma of testosterone supplementation therapy.

Study on the Effect of Porcine Placental Extract Ingestion on Symptoms of Late-onset Hypogonadism Syndrome in Middle-aged and Elderly Men / 日本補完代替医療学会誌

Purpose: An open-label, single-arm study was conducted to evaluate the effectiveness of porcine placental extract (PPE) ingestion to improve late-onset hypogonadism (LOH) syndrome symptoms. In addition, we reported the safety of continuous PPE ingestion in biochemistry tests.Materials and Methods: Test food containing PPE was given daily to healthy male subjects with an Aging Males’ Symptoms (AMS) score of ≥27, who were assessed as having LOH syndrome. AMS score, blood hormone level, and other parameters were measured before the start of PPE ingestion, Week 4, and Week 8. And adverse events that occurred during the ingestion period were accumulated.Results: Excluding one subject who withdrew from the study due to an adverse event unrelated to the test food, 14 subjects were included in the analysis. In terms of AMS score, no improvement was observed at Week 4, whereas a significant improvement was observed at Week 8. AMS scores were further categorized into three subscales (psychological, somatic, and sexual) and analyzed. The results showed a significant improvement from baseline in somatic scores at Week 8. Meanwhile, no significant change in sexual hormone levels was observed. At Week 8, improvements from baseline were observed in renal function and LDL cholesterol level. There were no adverse events related to the test food.Conclusion: The study demonstrated that 8-week PPE ingestion in middle-aged and elderly men can improve LOH syndrome symptoms while having little effect on sexual hormone secretion.

Effects of individualized testosterone replacement therapy on serum total testosterone and sex hormone levels in male patients with late-onset hypogonadism / 实用医学杂志

Objective To observe the effects of individualized testosterone replacement therapy on serum total testosterone(TT)and sex hormone in males with late-onset hypogonadism(LOH). Methods A total of 78 cases with LOH males were divided into group A(TT<8 nmol/L)and group B(8≤TT<11.5 nmol/L)according to the serum TT level,and the B group was randomly divided into the B1 group and the B2 group.They were given the individualized testosterone replacement therapy,and the treatment effect was compared among the 3 groups. Results After treatment,the SHBG level in the 3 groups was significantly reduced(P<0.05)whereas the serum TT level was significantly higher(P<0.05). The TT level in the B1 group was significantly higher than that in the B2 group(P ＜0.05). The levels of E2and FSH in the 3 groups were significantly lower(P ＜0.05)whereas the level of P was significantly higher(P ＜0.05). The ADAM scores in the 3 groups were significantly better than those before treatment(P<0.05),and there was no significant difference between the B1 group and the B2 group (P ＞0.05). There was no significant difference in the total incidence rate of adverse reactions between the group A and the other two groups(P ＞0.05),and the rate in the B2 group was lower than that in the B1 group(P <0.05). Conclusions In supplementary treatment of LOH,TT ＜8 nmol/L recommended to choose conventional dose,and 8≤TT<11.5 nmol/L can choose a small dose of testosterone.

Nivel de información sobre el síndrome de declinación de la función testicular en el envejecimiento masculino / Level of information on the declining testicular function syndrome in male aging

Introducción: el síndrome de declinación de la función testicular del hombre que envejece ha cobrado relevancia reciente, pero se asume que se conoce poco. Objetivo: identificar el nivel de información, en población y proveedores de salud, sobre este síndrome. Métodos: estudio descriptivo transversal, que involucró a 452 personas de población general, 109 médicos especialistas afines al tema y 406 de atención primaria. Se emplearon cuestionarios autoadministrados, estadísticas descriptivas y prueba chi2. Resultados: de la muestra poblacional 70,30 por ciento de las mujeres y 56,0 por ciento de los hombres reconocieron que el hombre experimenta un proceso equivalente al climaterio femenino; 64,04 por ciento no conocía los síntomas y 47,12 por ciento de los hombres mayores de 40 años señalaron edad de comienzo superior a la suya. De los especialistas afines, solo 10 habían oído hablar de todos los términos que se emplean para referirse al síndrome, 77,06 por ciento habían escuchado frecuentemente andropausia y 70,65 por ciento climaterio masculino; 27,52 por ciento dio definiciones incorrectas. De atención primaria, 28,57 por ciento no reconoció ningún término, 21,18 por ciento había escuchado frecuentemente andropausia y 19,95 por ciento climaterio masculino; 51,7 por ciento no definió correctamente el síndrome. El 74,14 por ciento no mencionó síntomas, 76,85 por ciento señaló contraindicaciones excesivas al tratamiento y 85,22 por ciento valoró su conocimiento como insuficiente. El nivel de información no se relacionó con edad, sexo o tiempo de graduado (p> 0,05). Conclusiones: la población, principalmente las mujeres, reconoce el síndrome, pero no domina sus manifestaciones. En médicos, con independencia de la edad, sexo o tiempo de graduado, la información se limita mayoritariamente a términos como andropausia y climaterio masculino; el dominio conceptual, del cuadro clínico y tratamiento, es insuficiente(AU)

Introduction: declining testicular function syndrome of the aging man has gained recent relevance but it is accepted that little is known about it. Objective: to find out the level of information of the population and of the health providers on this syndrome. Methods: cross-sectional and descriptive study involving 452 people from the general population, 109 medical specialists related to this topic and 406 primary care physicians. Self-administered questionnaires, summary statistics and chi-square test were all used. Results: in the population sample, 70.30 percent of women and 56 percent of men admitted that man experiences a process similar to the female climaterium; 64.04 percent did not know the symptoms and 47.12 percent of men older than 40 years stated that this process occurred at an age above that of theirs. As to the related specialists, just 10 had heard about all the terms used to mention this syndrome, 77.06 percent had often heard the term andropause and 70.65 percent the term male climaterium, and 27.52 percent gave incorrect definitions. In the primary health care physician group, 28.57 percent did not recognize any term, 21.18 percent had frequently heard about andropause and 19.95 percent about male climaterium, and 51.7 percent did not give a correct definition of the syndrome. In the sample 74.14 percent did not mention any symptom, 76.85 percent pointed out excessive treatment contraindications and 85.22 percent assessed their knowledge as poor. The level of information was not associated to age, sex or time of graduation (p> 0.05). Conclusions: the population, mainly women, recognizes the syndrome but did not know well the symptoms. Regardless of age, sex or time of graduation, the physicians' information about the syndrome is mostly limited to terms such as andropause and male climaterium but they did not master the concept, the clinical picture or the treatment(AU)

Establishment of a rat model of benign prostatic hyperplasia complicated with late-onset hypogonadism / 第二军医大学学报

Objective To establish and assess a rat model of benign prostatic hyperplasia (BPH) complicated with late-onset hypogonadism (LOH). MethocSs A total of 80 SD rats were randomly divided into 4 groups: control group, BPH complicated withLOH (model) group, BPH group andLOH group, with 20 rats in each group. In the model group, intraperitoneal injection of cyclophosphamide (20 mg/[kg · d]) was continuously administered for 5 days, followed by continuous intraperitoneal injection of testosterone propionate (50 mg/[kg · d]) for 28 days; the rats in the BPH group were treated the same as that in the model group, except with the same volume normal saline instead of cyclophosphamide; in the LOH group with same volume lucca oil instead of testosterone propionate; and in the control group, the rats were treated withsame volumenormal saline instead of cyclophosphamide and lucca oil instead of testosterone propionate. Two days after drug withdraw, serum testosterone was detected andweight loading swimming test, tall suspension test and sexual behavior test were performed. Then prostate weight and pathology were determined after the rats were sacrificed by cervical dislocation. Results The mean prostate indexes of rats in the LOH, model, control and BPH groups were 1. 58 ± 0. 13, 2. 93 ± 0. 19, 2. 33 ± 0. 13 and 3 23 ± 0. 11, respectively; serum testosterone levels were (4. 91 ± 1. 06), (9. 52 ± 1. 02), (12. 59 ± 0. 70) and (19. 69 ± 0. 56) ng/mL, respectively; the tail suspension struggling times were 97. 40 ± 15. 86, 120. 40 ± 14. 06, 223. 83 ± 16. 51, and 235. 29 ± 18. 77, respectively; the weight loading swimming timeswere (74. 27 ± 9. 29), (167. 47 ± 23. 35), (302. 33 ± 30. 10) and (261. 59 ± 35. 13) s, respectively; the times of olfactory sensation were 1. 53 ± 0. 52, 3 07 ± 0. 88, 9. 17 ± 1 30 and 9. 59 ± 1. 12, respectively; themean ride across times were 0. 33 ± 0. 49, 0. 47 ± 0. 52, 2. 11 ± 0. 47 and 2. 29 ± 0. 47, respectively. Statistical analyses showed that there were significant differences among the four groups in mean prostate index, serum testosterone level and tall suspension struggling time (P<0. 05, P<0. 01), in weight loading swimming time and time of olfactory sensation (P<0. 01) except between control group and BPH group, and in mean ride across time (P<0. 01) except between control group and BPH group, andmodel group and LOH group. Conclusion A BPH complicated with LOH rat model was successfully established with intraperitoneal injection of cyclophosphamide and testosterone propionate.

Oral Testosterone Undecanoate Capsules combined with Qilin Pills for late-onset hypogonadism in males / 中华男科学杂志

Objective@#To investigate the clinical effects of oral Testosterone Undecanoate Capsules (TUC) combined with Qilin Pills (QLP) on late-onset hypogonadism (LOH) in men.@*METHODS@#Sixty-three LOH patients meeting the inclusion criteria were randomly divided into a control group (aged ［48.4 ± 6.2］ yr, n = 32) and an experimental group (aged ［47.2 ± 5.6］ yr, n = 31) to be treated with oral TUC (80 mg, qd) and TUC + QLP (6g, tid), respectively, both for 3 months. Comparisons were made between the two groups of patients in the IIEF-5 scores, total testosterone (TT) levels, and scores in the Aging Males' Symptoms (AMS) scale before and after treatment.@*RESULTS@#After treatment, the patients of the experimental group, as compared with the controls, showed a significantly increased IIEF-5 score (21.7 ± 5.8 vs 15.9 ± 4.7, P <0.05) and TT level (［16.7 ± 2.2］ vs ［13.1 ± 2.8］ nmol/L, P <0.05), but a decreased AMS score (20.7 ± 5.7 vs 31.3±6.5, P <0.05).@*CONCLUSIONS@#TUC combined with Qilin Pills has a better effect and a lower rate of adverse reactions than TUC used alone in the treatment of late-onset hypogonadism in males.

Diagnostic criteria for late-onset hypogonadism: A preliminary study / 中华男科学杂志

<p><b>Objective</b>To determine the stability of androgen indexes by analyzing the relationship of androgen indexes with the results of late-onset hypogonadism (LOH) questionnaire investigations, and offer some reference for the application of the diagnostic criteria for LOH released by The Chinese Society of Andrology in 2009.</p><p><b>METHODS</b>This study included 1 003 males aged 40 years or older who had accomplished the questionnaires of Androgen Deficiency in Aging Males (ADAM), Aging Males' Symptoms Scale (AMS), and International Index of Erectile Function-5 (IIEF-5). We evaluated the correlation of androgen indexes with the results of the questionnaire investigation, repeated the examination of androgen indexes for the subjects with total testosterone (TT) ≤11.5 nmol/L after an average of 1.5 years, and analyzed the factors inducing changes of androgen indexes.</p><p><b>RESULTS</b>Free testosterone index (FTI) ≤ 0.42 (OR, 1.369) and calculated free testosterone (cFT) ≤ 0.3 nmol/L (OR, 1.302) were considered as the risk factors of LOH in AMS, and so were testosterone secretion index (TSI) ≤ 2.8 nmol/IU (OR, 1.679) and cFT ≤ 0.3 nmol/L (OR, 1.371) in IIEF-5. Paired t-test on the results of the examination performed twice showed significant differences in the levels of TT, TSI, cFT, and FT (P<0.05).</p><p><b>CONCLUSIONS</b>Decreased testosterone may cause the diversity of LOH symptoms and hence the fluctuation of androgens. Therefore, the diagnosis of LOH depends on androgen indexes, varied symptoms in the questionnaires, and relief of the symptoms after testosterone therapy.</p>

Effects of long-term androgen replacement therapy on the physical and mental statuses of aging males with late-onset hypogonadism: A multicenter randomized controlled trial in Japan (EARTH Study) / 亚洲男科学杂志(英文版)

Androgen replacement therapy (ART) efficacy on late-onset hypogonadism (LOH) has been widely investigated in Western countries; however, it remains controversial whether ART can improve health and prolong active lifestyles. We prospectively assessed long-term ART effects on the physical and mental statuses of aging men with LOH in Japan. The primary endpoint was health-related quality of life assessed by questionnaires. Secondary endpoints included glycemic control, lipid parameters, blood pressure, waist circumference, body composition, muscular strength, International Prostate Symptom Scores (IPSS), International Index of Erectile Function-5 (IIEF-5) scores, and serum prostate-specific antigen levels. Of the 1637 eligible volunteers, 334 patients > 40 years with LOH were randomly assigned to either the ART (n = 169) or control groups (n = 165). Fifty-two weeks after the initial treatment, ART significantly affected the role physical subdomain of the short form-36 health survey (SF-36) scale (P = 0.0318). ART was also associated with significant decreases in waist circumstance (P = 0.002) and serum triglyceride (TG) (P = 0.013) and with significant increases in whole-body and leg muscle mass volumes (P = 0.071 and 0.0108, respectively), serum hemoglobin (P < 0.001), IPSS voiding subscore (P = 0.0418), and the second question on IIEF-5 (P = 0.0049). There was no significant difference between the groups in terms of severe adverse events. In conclusion, in patients with LOH, long-term ART exerted beneficial effects on Role Physical subdomain of the SF-36 scale, serum TG, waist circumstance, muscle mass volume, voiding subscore of IPSS, and the second question of IIEF-5. We hope our study will contribute to the future development of this area.

Curative effect of testosterone combined with solifenacin for patients with lower urinary tract symptoms in ;late-onset hypogonadism / 中国基层医药

Objective To investigate the clinical efficacy and safety of testosterone supplement and Mreceptor blockers in the treatment of patients with lower urinary tract symptoms(LUTS)in late -onset hypogonadism(LOH). Methods 28 cases diagnosed as LOH with mild to moderate LUTS were collected.They were given testosterone supplementation (oral testosterone undecanoate capsules,80mg,2 times/d)and M receptor blocker (oral succinate solifenacin tablet,5mg,1 time /d)treatment for 1 -3 months.After treatment for 1 month and 3 months respectively, reviewd PSA,serum total testosterone (TT),international prostate of urinary storage symptoms score (urinary storage IPSS),quality of life (QOL)score,international index of erectile function (IIEF -5)score,maximum urinary flow rate (Qmax),residual urine (Ru)and rectal examination (DRE).The improvement of LUTS before and after treatment was evaluated.Results 1 month after treatment,1 patient was difficult to tolerate the solifenacin side effects and took testosterone supplementation alone.The rest 27 patients were able to take medicine for 3 months.After 1 month and 3 months treatment,the IPSS score had significant differences compared with before treatment[(10.3 ±2.1)points vs (14.2 ±3.3)points and (9.42 ±1.8)points vs (14.2 ±3.3)points,t =13.67,14.72,all P <0.05 ].After 3 months treatment,the QOL and IIEF -5 scores were (2.1 ±0.7)points vs (4.3 ±0.6)points and (16.8 ± 3.6)points vs (11.9 ±2.5)points,Qmax was (12.5 ±5.6)mL/s vs (9.8 ±4.8)mL/s(t =6.42,5.64,14.92,all P <0.05 ),the difference was statistically significant compared with before treatment.There were no significant changes in PSA and RU before and after treatment.All patients had no severe complications such as acute urinary retention.Conclusion Combination of testosterone and testosterone in the treatment of LUTS patients in LOH is safe and effective,and can significantly improve the LUTS and quality of life.

Testosterone replacement therapy on male late-onset hypogonadism with Mild-to-moderate benign prostate hy-perplasia / 局解手术学杂志

Objective To explore the safety and efficacy of testosterone replacement therapy in patients with male late-onset hypogon-adism and Mild-to-moderate benige prostate hyperplasia. Methods Forty-three patients diagnosed as male late-onset hypogonadism and Mild-to-moderate benige prostate hyperplasia were selected,of which 28 patients were assigned to Eleven acid testosterone (40 mg each time, after a meal,2 times per day) ,other patients were in the control group. The patients were followed for 12 months and their data about digital rectal inspection,size of the prostate,IPSS score,maximum urinary flow rate ( Qmax) ,AMS clinical symptom score,serum testosterone level, serum PSA level,RBC hematocrit ( HCT) ,and other indicators were collected. Results Twelve months After testosterone replacement thera-py,both the prostate volume of treated and control groups were not significantly changed(P>0. 05). IPSS score and maximum urinary flow rate in treatment group were improved significantly(P0. 05). Baseline AMS clinical symptom score and blood testosterone level were similar between treatment and control group (P >0. 05). Twelve months after treatment,the blood testosterone level of the treatment group reached the normal range,and the AMS clinical symptom scores de-creased significantly (P0. 05). Conclusion Testosterone replacement therapy in patients with male late-onset hypogonadism and the Mild-to-moderate benige prostate hyperplasia is safe and effective.

Annual advance of the research on gonadal disorders from August 2013 to July 2014 / 中华内分泌代谢杂志

[Summary] Over the past year, researches in the field of gonadal diseases have achieved rapid advances. Considerable literatures concerning the diagnosis and treatment of these diseases have been published. We herely reviewed and analyzed literatures which may be helpful to clinical practice in the future, while the defects and deficiencies in this field in China were also discussed with some suggestions proposed for the future.

<b>Hochuekkito Efficacy in Late-Onset Hypogonadism (LOH) Patients </b> / 日本東洋医学雑誌

The purpose of this study is to evaluate the efficacy of hochuekkito for late-onset hypogonadism (LOH) patients. We administered hochuekkito 7.5 g/day for 8 weeks to 47 patients with LOH whose AMS scale was more than 27. We assessed the patients' symptom change with the AMS, SHIM, SDS, BDI, and SF-36. We measured their endocrine profiles and levels of their cytokines. At the end of study, 31 of 47 patients were evaluable. No significant difference in subjective symptoms was seen with any questionnaire after 8 weeks hochuekkito administration. However, hochuekkito significantly increased free testosterone and decreased ACTH/cortisol levels. Thus we believe hochuekkito is beneficial for the treatment of LOH.

Análisis preliminar del cuestionario Potenziani para la validación diagnóstica del hipogonadismo de comienzo tardío y su concordancia con los cuestionarios de Heinemann (AMS) y de Morley (ADAM) / Preliminary analysis of the Potenziani questionnaire for the late onset hypogonadism diagnostic validation and its concordance with the Heinemann (AMS) and Morley (ADAM) questionnaires

Hipogonadismo de comienzo tardío, es una condición que afecta 6% al 12% de hombres entre 40 y 70 años y aun así, está subdiagnosticada, por lo que se propone un cuestionario de validación diagnóstica, con el objetivo de lograr mayor sensibilidad, especifidad y predictividad que los cuestionarios ya existentes. Se analizaron 107 hombres entre 45 y 70 años, con disminución del entusiasmo en actividad diaria, cansancio fácil, menor productividad en su trabajo, cambios del humor con propensión a la irritabilidad, disminución de su masa magra muscular, con tendencia al sobrepeso y afectación en actividades recreativas y deportivas. Se hizo interrogatorio exhaustivo, examen físico y pruebas de laboratorio (perfil 20, perfil hormonal urológico masculino, antígeno prostático específico total, libre y relación libre/total, examen de orina y urocultivo). Se solicitó contestar al paciente tres cuestionarios de validación diagnóstica del hipogonadismo de comienzo tardío: Heinemann AMS (Ageing Males Survey-1999, St. Louis University, Androgen Deficiency in Aging Male), Morley ADAM-2000 y el cuestionario de validadción diagnóstica del hipogonadismo de comienzo tardío-Potenziani-2007, para ser comparados y demostrar su validez con pruebas de especificidad y sensibilidad, índice de Youden, pruebas de concordancia con intervalos de confianza del 95%, en relación al diagnóstico bioquímico del hipogonadismo de comienzo tardío. Los resultados arrojaron que el cuestionario "Potenziani" fue más sensible (88,57%), fue más específico (41,67%), tuvo el índice de validez más alto (57,01%) y el valor predictivo positivo más alto de los tres cuestionarios con el 42,5%. Por tal motivo se ha demostrado que el cuestionario propuesto es más adecuado que Heineman-AMS y el Morley-ADAM en la aproximación diagnóstica del síndrome de hipogonadismo de comienzo tardio

Late onset hypogonadism a condition which affect 6%-12% of men between 40-70 years old, and still it is subdiagnosed for which we did a validation questionnaire with the objetive to be more sensitive, especific and predictive that old questionnaires. We analized 107 men with ages between 45-70 years old whom consulted for libido deterioration, erectile dysfunction, less enthusiasm of daily life, less work-productivity, easy tiredness, humor changes with irritability, less muscle mass, overweight, and deterioration of sexual life in general. We performed exhaustive interrogatory, physical examination, and laboratoty test (20 profile, hormonal-urologic profile, prostatic specific antigen, urine and urocultive). We ask them to complete three questionnaires of late onset hypogonadism diagnostic validation: Heinemann AMS, Morley ADAM, Potenziani 2007, to be compared and show its validity with specificity and sensibility tests, Youden Index, test of concordance with confidence interval of 95%, in relation to biochemical diagnosis of deficiency testosterone syndrome. The results were that the Potenziani`s cuestionary was more sensible (88.57%), more specific (41.67%), with the validation index more high (57.01%) and with the positive predictive value more high too (42.5%). For that reason we show that Potenziani`s validation questionnaire of late onset hypogonadism, is more adecuate in the diagnostic aproximation of this condition

Short term testosterone replacement therapy improves libido and body composition / Reposição de testosterona a curto prazo melhora libido e composição corporal

OBJECTIVE: To assess the efficacy and safety of testosterone replacement in males with late-onset hypogonadism compared to hypogonadal men without replacement, and controls, during six months. METHODS: We assessed, through ADAM, AMS, IIEF-5 and SF-36 questionnaires, and through clinical and laboratorial examinations, 62 patients divided into three groups: 17 hypogonadal males (HR) used intramuscular testosterone every three weeks; 14 hypogonadal males (HV) and 31 non-hypogonadal males (CV) used oral vitamins daily. RESULTS: When compared to others, HR group obtained libido improvement assessed by ADAM 1 (p = 0.004), and borderline sexual potency improvement assessed by IIEF-5 (p = 0.053), besides a decrease in waist circumference after eight weeks (p = 0.018). The remaining parameters did not differ between the groups. PSA and hematocrit remained stable in those using testosterone. CONCLUSION: Six months of testosterone replacement improved sexuality and body composition, with prostatic and hematological safety.

OBJETIVO: Avaliar a eficácia e a segurança da reposição de testosterona em homens com hipogonadismo tardio comparados a hipogonádicos sem reposição e controles, durante seis meses. MÉTODOS: Mediante os questionários ADAM, AMS, IIEF-5 e SF-36, foram feitos exame clínico e laboratorial em 62 pacientes divididos em três grupos: 17 hipogonádicos (HR) usaram testosterona intramuscular a cada três semanas; 14 hipogonádicos (HV) e 31 não hipogonádicos (CV) usaram vitaminas via oral diariamente. RESULTADOS: Comparado aos demais, o grupo HR obteve melhora da libido avaliada pelo ADAM 1 (p = 0,004) e melhora limítrofe da potência sexual avaliada pelo IIEF-5 (p = 0.053), além de diminuição da cintura a partir da oitava semana (p = 0,018). Os demais parâmetros não foram diferentes entre os grupos. PSA e hematócrito se mantiveram estáveis nos que usaram testosterona. CONCLUSÃO: A reposição de testosterona durante seis meses melhorou a sexualidade e a composição corporal, com segurança prostática e hematológica.

A Manual of 2008 ISA, ISSAM, EAU, EAA and ASA Recommendations: Investigation, Treatment and Monitoring of Late-onset Hypogonadism in Males / 대한남성과학회지

The 2008 new recommendations from professional societies including ISA, ISSAM, EAU, EAA and ASA on the investigation, treatment and monitoring of late-onset hypogonadism in males provide updated evidence-based informations for clinicians who diagnose and treat patients with adult-onset, age-associated testosterone deficiency

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).