The prostate after castration and hormone replacement in a rat model: structural and ultrastructural analysis

ABSTRACT Purpose: To evaluate if late hormonal replacement is able to recover the prostatic tissue modified by androgenic deprivation. Materials and Methods: 24 rats were assigned into a Sham group; an androgen deficient group, submitted to bilateral orchiectomy (Orch); and a group submitted to bilateral orchiectomy followed by testosterone replacement therapy (Orch+T). After 60 days from surgery blood was collected for determination of testosterone levels and the ventral prostate was collected for quantitative and qualitative microscopic analysis. The acinar epithelium height, the number of mast cells per field, and the densities of collagen fibers and acinar lumen were analyzed by stereological methods under light microscopy. The muscle fibers and types of collagen fibers were qualitatively assessed by scanning electron microscopy and polarization microscopy. Results: Hormone depletion (in group Orch) and return to normal levels (in group Orch+T) were effective as verified by serum testosterone analysis. The androgen deprivation promoted several alterations in the prostate: the acinar epithelium height diminished from 16.58±0.47 to 11.48±0.29μm; the number of mast cells per field presented increased from 0.45±0.07 to 2.83±0.25; collagen fibers density increased from 5.83±0.92 to 24.70±1.56%; and acinar lumen density decreased from 36.78±2.14 to 16.47±1.31%. Smooth muscle was also increased in Orch animals, and type I collagen fibers became more predominant in these animals. With the exception of the densities of collagen fibers and acinar lumen, in animals receiving testosterone replacement therapy all parameters became statistically similar to Sham. Collagen fibers density became lower and acinar lumen density became higher in Orch+T animals, when compared to Sham. This is the first study to demonstrate a relation between mast cells and testosterone levels in the prostate. This cells have been implicated in prostatic cancer and benign hyperplasia, although its specific role is not understood. Conclusion: Testosterone deprivation promotes major changes in the prostate of rats. The hormonal replacement therapy was effective in reversing these alterations.

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

Deficiência androgênica na mulher / Androgen deficiency in women

As evidências sugerem que a deficiência androgênica na mulher exibe como principal manifestação clínica a disfunção sexual, especialmente a queda da libido. Entretanto, outros fatores podem também estar implicados na gênese da disfunção sexual, como o relacionamento interpessoal, os estressores sociais, o sedentarismo e o próprio fator masculino. A prevalência da disfunção sexual feminina oscila entre 9 por cento e 43 por cento e recentemente muitos estudos têm mostrado que a reposição com androgênios não só melhora o desempenho sexual, mas também os distúrbios do humor e sintomas vasomotores. Por isso, o profissional de saúde deve sempre incluir no diagnóstico diferencial da disfunção sexual a Síndrome de Deficiência Androgênica, mesmo em mulheres com concentrações séricas normais de estrogênios. O presente artigo tem como objetivo revisar os aspectos práticos da Síndrome de Deficiência Androgênica, enfocando especialmente o diagnóstico e tratamento. Para tanto, nos valemos da análise de 105 artigos publicados em revistas indexadas no PUBMED nos últimos 51 anos (até maio de 2010), incluindo consensos e opiniões de especialistas. Como conclusão, a Síndrome de Deficiência Androgênica na mulher é negligenciada, existindo ainda muitas controvérsias quanto ao seu diagnóstico e terapêutica, especialmente no tocante à escolha do androgênio, a via de administração e o tempo de duração de uso.

The evidences suggest that androgen deficiency in women induces sexual dysfunction as the main clinical manifestation, especially reduction of libido. However, other factors may be involved in the disease genesis, such as interpersonal relationships, social stressors, sedentarism and the partner. Prevalence of sexual problems among women ranges from nine to 43 percent and, recently, many studies have reported that androgens are beneficial not only for the sexual function of women, but for mood disorders and vasomotor symptoms. That is why the physician should include androgen deficiency syndrome as differential diagnosis, even in women with adequate levels of estrogen. Our goal was to present practical aspects of this disease, emphasizing diagnosis and focusing on treatment. This survey covered all the publications indexed in PUBMED in the last 51 years ending May 2010, including consensus and expert opinions; 105 articles were identified. We conclude that the syndrome of androgen deficiency in women is overlooked in clinical practice. There is controversy in literature regarding diagnosis and treatment including choice of drug, route of administration and time of application.

The role of testosterone in type 2 diabetes and metabolic syndrome in men: [review] / O papel da testosterona no diabetes melito tipo 2 e síndrome metabólica em homens: [revisão]

Over the last three decades, it has become apparent that testosterone plays a significant role in glucose homeostasis and lipid metabolism. The metabolic syndrome is a clustering of risk factors predisposing to diabetes mellitus type 2, atherosclerosis and cardiovascular morbidity and mortality. The main components of the syndrome are visceral obesity, insulin resistance, glucose intolerance, raised blood pressure and dyslipidemia (elevated triglycerides, low levels of high-density lipoprotein cholesterol), and a pro-inflammatory and thrombogenic state. Cross-sectional epidemiological studies have reported a direct correlation between plasma testosterone and insulin sensitivity, and low testosterone levels are associated with an increased risk of type 2 diabetes mellitus, dramatically illustrated by androgen deprivation in men with prostate carcinoma. Lower total testosterone and sex hormone-binding globulin (SHBG) predict a higher incidence of the metabolic syndrome. There is evidence that hypotestosteronemia should be an element in the definition of the metabolic syndrome since low levels of testosterone are associated with or predict the development of the metabolic syndrome and of diabetes mellitus. Administration of testosterone to hypogonadal men reverses part of the unfavorable risk profile for the development of diabetes and atherosclerosis. So far, studies on the effects of normalization of testosterone in hypogonadal men on glucose homeostasis are limited, but convincing, and if diabetes mellitus is viewed in the context of the metabolic syndrome, the present results of testosterone treatment are very encouraging.

Ao longo das últimas três décadas, tornou-se evidente que a testosterona desempenha um papel significativo na homeostase da glicose no metabolismo lipídico. A síndrome metabólica é um agrupamento de fatores de risco que predispõem ao diabetes melito tipo 2, aterosclerose e morbidade e mortalidade cardiovasculares. Os principais componentes da síndrome são: obesidade visceral, resistência insulínica, intolerância à glicose, hipertensão arterial e dislipidemia (triglicerídeos elevados, baixos níveis de HDL-colesterol), além de um estado pró-inflamatório e trombogênico. Estudos epidemiológicos transversais relataram uma correlação direta entre testosterona plasmática e sensibilidade à insulina, e níveis baixos de testosterona se associam com risco aumentado de diabetes tipo 2, ilustrado dramaticamente pela privação androgênica em homens com carcinoma de próstata. Baixos níveis de testosterona total e globulina transportadora de hormônios sexuais (SHBG) predizem maior incidência de síndrome metabólica. Existem agora evidências de que a hipotestosteronemia deveria ser um elemento na definição da síndrome metabólica, uma vez que baixos níveis de testosterona estão associados ou predizem o desenvolvimento de síndrome metabólica e de diabetes melito. A administração de testosterona a homens hipogonádicos reverte parte do perfil desfavorável de risco para o desenvolvimento de diabetes e aterosclerose. Até agora, os estudos relacionados aos efeitos da normalização da testosterona em homens hipogonádicos sobre a homeostase da glicose são limitados, mas convincentes e, se o diabetes melito for visto no contexto da síndrome metabólica, os resultados atuais do tratamento com testosterona são muito encorajadores.

Deficiencia androgénica en hombres de 60 años y más del área de salud Vedado / Androgen deficiency in men aged 60 or more from Vedado health area

El declinar de la función testicular propia del envejecimiento ha adquirido relevancia en los últimos años, sin embargo aún no se conoce su prevalencia, ni existe uniformidad para el diagnóstico. Se realizó un estudio descriptivo transversal con el objetivo de determinar la prevalencia y características clínico-hormonales del déficit androgénico en varones de 60 años y más. Se incluyeron 70 sujetos de un área de salud, seleccionados mediante muestreo aleatorio estratificado polietápico, a los cuales se interrogó sobre la presencia de síntomas de deficiencia androgénica, se les realizó examen físico general y genital y determinaciones de testosterona total, hormona luteinizante y hormona folículo estimulante en sangre periférica. De acuerdo con las concentraciones de la testosterona se dividieron en 2 grupos: a) sujetos con deficiencia androgénica y b) sujetos sin deficiencia androgénica. Los que presentaron déficit androgénico tenían un peso significativamente superior, una proporción mayor de obesidad y una talla significativamente inferior. Los síntomas de déficit androgénico fueron frecuentes, los refirieron indistintamente los integrantes de ambos grupos y se presentaron independientemente de las concentraciones de las hormonas sexuales. En general, las gonadotropinas estaban aumentadas fundamentalmente a expensas de hormona folículo estimulante y su comportamiento fue independiente de las concentraciones de testosterona(AU)

Decline of testicular function typical of aging has acquired relevance in past years, however yet it is unknown its prevalence and there is not evenness for its diagnosis. A cross-sectional and descriptive study was made to determine the prevalence and clinical-hormonal features of androgen deficit in males aged 60 or more. Included are 70 subjects from a health area selected by multistage stratified randomized sampling that were interrogated about presence of androgen deficiency syndrome and underwent a physical and genital examination and total testosterone determinations, luteinizing hormone and follicle-stimulating hormone in peripheral blood. According the testosterone concentrations they were divided into two groups: a) subjects presenting with androgen deficiency and b) subjects without this type of deficiency. Those with androgen deficit had a higher weight, a higher obesity ratio, and a significantly lower height. The symptoms of androgen deficit were frequent, recounted indiscriminately by both groups and independently of sexual hormone concentrations. Generally, gonadotropins were increased mainly at the expense of follicle-stimulating hormone and its behavior was independent of the testosterone concentrations(AU)

Síndrome de deficiencia de testosterona y su impacto en la salud masculina / Testosterone deficiency syndrome and its impact in adult male pathology

El Síndrome de Deficiencia de Testosterona constituye hoy en día una entidad relevante dentro de las patologías del hombre adulto. Contrariamente a los mitos existentes, la evidencia científica actual demuestra que la Testosterona no sólo está involucrada en el área sexual y reproductiva, sino también en muchos otros sistemas como el cardiovascular, el metabolismo lipídico, la composición corporal, el metabolismo óseo, la función cerebral y el sistema hematopoyético. En todos ellos, su deficiencia puede generar serios efectos que implican un severo impacto en la calidad de vida del hombre mayor. Por otra parte, el conocimiento médico actual permite hoy en día reemplazar esta hormona sin temores. Sabemos que la testosterona no induce la aparición de cáncer de próstata así como también aquellos hombres con testosterona plasmática baja tienen más riesgo de hacer este cáncer así como también más agresivos. El reemplazo hormonal, con la consecuente restauración de los niveles plasmáticos de testosterona genera una mejoría en cada uno de los sistemas afectados lo que finalmente se traduce en una mejoría en la calidad de vida.

The testosterone deficiency syndrome is currently a well established entity amongst adult male pathology. Current evidence demonstrates testosterone involvement not only in sexual and reproductive physiology but also as an active participant in other systems. Cardiovascular system, lipid metabolism, body composition, bone metabolism, brain function and hemathopoyetic system are all severely affected by androgen deficiency. It is well known that testosterone administration does not induce prostate cancer nor it is associated with a higher risk of high grade cancer in the hypogonadic male. Now a days testosterone can be administered without fear. Hormone replacement therapy with normalization of plasmatic testosterone levels is associated with a recovery of all systems affected and consequently an improvement in quality of life.

Enfermedad de Addison en una gemela de 19 meses / Addison´s disease in a 19 months old twin girl

La enfermedad de Addison, o insuficiencia adrenal primaria, es una entidad en la cual la corteza adrenal secreta cantidades insuficientes de glucocorticoides, mineralocorticoides y andrógenos debido a un daño adrenal. Se presenta el caso de una niña de 19 meses con una historia de fatiga crónica, pérdida de peso, vómitos, hiporexia e hiperpigmentación en piel labios y encías. Estos signos y síntomas tenían dos meses de evolución y empeoraron hasta que el diagnóstico correcto fue hecho y el tratamiento adecuado fue iniciado. Es una de las pacientes más jóvenes diagnosticada con enfermedad de Addison en Costa Rica, así como una edad de presentación temprana comparada con el promedio para esta patología. Se compara la paciente con su hermana gemela sana, de manera que los signos de la enfermedad son aún más evidentes y se presenta una revisión de la enfermedad de Addison como diagnóstico que debe estar presente en el diferencial de todo médico general

Early development of osteoporosis in male smokers with hypoandrogenism due to fascioliasis with or without schistosomiasis added by life style

The rnultifactor outcome of hypoandrogenemia with the impact of oxidative stress induced by glucose intolerance, fascioliasis with or without schistosomiasis and cumulative smoking influence on bone remodeling and the early development of osteo-porotic manifestations were studied. The effect on vascular endothelium immune mediated mechanisms and antioxidant capacity were monitored in cases of youth aged selected male smokers involving 20 with hypoandrogenemia who were either subjected to sedentary life style, glucose intolerance fascioliasis hepatic fibrosis [FHF] [G1] or without [G2] and GI after following 6 months therapy [G3]. Monitoring of clinical picture and biochemical assessments of osteoporotic indices [osteocolcin, bone alkaline phosphatase, parathyroid hormone, urinary cyclic AMP], hypoandrogenism [dehydroepiandrosterane sulphate or DHEAS and testosterone] glycemic determinant [insulin] immuno-inflammatory response [inter-leukein-6, tumor necrosis factor a, E-selectin, ceruloplasmin] smoking index [serum cotinine], total antioxidant capacity [AOC] and lipid peroxidation [malonedialdehyde] was done before and after 6 months therapeutic program involving supplement of DHEAS, mirazid, chromium picolinate, and megavit zinc alongside smoking cessation and physical exercise daily for at least 30 minutes. Treatment with Mirazid supplied as 10 mg/kg for 6 successive days resulted in 100% cure of fascioliasis whether single or combined with schistosomiasis

Sexualidade e hormônios na transição menopausal e na pós-menopausa / Sexuality and hormones in menopausal transition and after the menopause

A síntese dos esteróides segue seqüência consagrada. Dois sistemas enzimáticos são importantes para a biotransformação das diversas substâncias: hidrogenases e citocromo P450. Tanto os estrogênios como os androgênios são relevantes para o desenvolvimento e manutenção da troficidade das estruturas genitais, além de muitas outras ações metabólicas em todo o organismo. Há queda na síntese dos androgênios a partir da terceira década da vida da mulher, podendo agravar-se em situações especiais. Algumas mulheres têm manifestações clínicas, impondo-se a suplementação terapêutica. É também inegável a ação dos esteróides sexuais no sistema nervoso central. Experiências em aves e animais comprovaram essas influências. Malgrado outros estímulos na atividade sexual - olfato, visão, tato - e de várias substâncias - vasopressina, ocitocina, dopamina, é inegável o fator preponderante dos esteróides sexuais. A insuficiência androgênica (IA) pode manifestar-se com sinais e sintomas peculiares. A reposição androgênica poderá melhorar tanto a sexualidade quanto o bem-estar das pacientes.

The steroid biosynthesis follows a time-honored sequence. Two enzymatic groups are important in this action: hydrogenases and cytochrome P450. Both estrogens and androgens act on the development and trophicity of genital organs besides other metabolic actions. Female androgen secretion declines, starting in the thirties, with aggravation in particular clinical situations needing therapeutic supplementation. The action of sexual steroids on the Central Nervous System is well established. Experiments with birds and animals prove this action. Despite the influence of smell, vision, tact and substances such as vasopressin, oxytocin, and dopamine, it is indisputable that the sexual steroids play the major role in sexual activity. Androgen insufficiency (AI) may exhibit signs and symptoms in particular clinical situations. Replacement therapy (androgens) may improve well-being and sexual activity.

Falência ovariana precoce (questões básicas no diagnóstico e tratamento) / Premature ovarian failure (basic questions and treatment)

Falência ovariana precoce (FOP) é uma condição ginecológica com importantes repercussões médicas e psicossoais. Mulheres portadoras de FOP apresentam risco de co-morbidades como insuficiência adrenal e osteoporose. A realização do diagnóstico correto e precoce depende do conhecimento dos sintomas iniciais e das causas dessa doença. Dentre as causas pode-se destacar síndrome do Turner, síndrome do X-frágil, doenças imunológicas, danos ao tecido ovariano, doença de Addison e síndrome de Perrault. A possibilidade do diagnóstico precoce reduz as complicações tardias associadas a essa doença e promove a oportunidade de tratamento específico para endocrinopatias, infertilidade e hipoestrogênismo

Premature ovarian failure (POF) represents a gynecological condition with important medical and psychosocial consequences. Women with POF have increased risk for other diseases such as adrenal insufficiency and osteoporosis. The correct and early diagnosis depends on the recognition of initial symptons and the causes of this disease. Amongst the causes are Turner Syndrome, immunological causes, Syndrome of X-Fragile, ovarian damage, Addison Disease and Perrault Syndrome. The early diagnosis reduces late complications associated to this pathology and provides a possibility to the specific treatment of endocrinopathies, infertility and estrogen deficiency

Enhanced coronary flow following experimental androgen deprivation by orchidectomy

Androgen deprivation is an effective treatment for patients with advanced prostate cancer. The present work was conducted to study the impact of testosterone deprivation on cardiac functions and coronary flow. Experimental androgen deprivation was induced in rats by orchidectomy, compared to sham-operated controls. Two weeks after operation, rats were subjected to measurements of body weight, plasma testosterone and ECG recording. Cardiac functions were studied on isolated perfused hearts in a Langendorff preparation, under basal conditions and following exposure to 30 minutes of global ischemia followed by another 30 minutes of reperfusion. The following parameters were assessed: heart rate [HR], peak tension [PT], time to peak tension [TPT], half relaxation time [HRT], and myocardial flow rate [MFR]. Absolute weights of different cardiac chambers and their relative weights were also determined. The orchidectoimzed [ORX] rats exhibited non significant changes in ECG parameters, significant increase in absolute weights of whole heart and left ventricle, associated with significant body weight gain. Hearts isolated from ORX rats displayed a significant increase in basal preischemic MFR compared to their matching controls. Upon isehemia reperfusion [I/R], MFR of hearts isolated from ORX rats was still higher compared to controls, After 30 minutes of reperfusion, hearts of control rats displayed non significant change in HR associated with significant decrease in MFR as compared to preisehemie values; while in hearts of ORX rats, HR was significantly decreased, and accompanied with non significant changes in MFR. The augmented MFR in response to I/R, in ORX rats,, was however associated with significant increase in TPT and HRT, indicating impaired ventricular contractility and delayed relaxation, respectively when compared to controls. Upon I/R, PT was preserved in ORX group, while it was deteriorated in the controls, as compared to the preischemia values. Expenmental androgen deprivation induced marked increase in coronary flow, possibly due to lack of the predominant vasoconstrietor effect of testosterone hormone

Karyotype revealed 47, xxy chromosome (Klinefelter syndrome): a case report.

The Klinefelter syndrome is most common chromosomal cause of male infertility. However, the many cases of the syndrome remain undiagnosed due to variations in clinical presentation. A patient attended to surgical OPD with complaints of loss of secondary sexual characteristics and infertility. Physical examination revealed tall stature, thin built, small testes size, and absence of beard and pubic hairs. Karyotype and biochemical tests were performed to detect chromosomal abnormality as well hormonal level to confirm the diagnosis of androgen deficiency syndrome. Chromosomal complement confirmed the case of Klinefelter syndrome (47, XXY) causing androgen deficiency. Timely detection of Klinefelter syndrome is important to formulate further treatment modalities for the benefit of the patient.

Tibone in the perimenopause for the treatment of androgen deficiency

A tibolona pode ser usada para tratar a deficiência androgênica na mulher na perimenopausa. O mecanismo de ação mais importante da tibolona é a redução dos níveis de SHBG e o aumento da testosterona livre. A tibolona também ativa a COX-2 no endométrio aumentando o risco de formação de pólipos endometriais. O aumento da testosterona livre com o uso da tibolona leva a um aumento de produção tecidual de estrogênios nos tecidos que expressam aromatase

Immunohistochemical study of male albino rat prostate in different age groups after castration

In this study we examined the lobe-specific and age-dependent expression of Bcl-2 and Bax proteins, 80 male albino rats were used in this study, 20 rats were control 10 aged 4 month, and 10 aged 24 months, the rest of animals were divided into 3 equal groups each 20 animals half of them 4 months age and the rest 24 months age. The experimental groups were castrated, and were killed at 1, 10, 30 days after castration. Bcl-2 expression in the ventral lobe were lower compared with expression in the dorsal and lateral lobes respectively. Bax expression in the ventral lobe was higher than that in the lateral and dorsal lobes, respectively. In all three lobes, Bcl-2 was detected in epithelial cells, but not in stromal cells, where as Bax. protein was localized in both cell types. After castration, Bcl-2 expression in the ventral lobe decreased significantly from the control level shortly after castration, but increased significantly by 30 days. By contrast, Bax expression increased significantly, gradually decreased by time, and was nearly undetectable by 30 days post-castration. In the dorsal and lateral lobes, neither Bcl-2 nor Bax expression was significantly altered after castration. In the ventral lobe of old rats after castration, Bcl-2 followed a pattern of expression similar to that observed in young rats. However, Bax were lower in old rats compared with those in young rats after castration. Therefore, cell death follows the down-regulation of Bcl-2 expression in the ventral lobe of young and old rats. Moreover, the higher Bcl-2 expression in the dorsal and lateral lobes of controls and in the ventral lobe by 30 days after castration serve to protect cells from apoptosis. The conclusion of the study was that; the rat prostate lobes offer a model to study the molecular mechanisms of cell death and survival that are related to the androgen dependence of prostate epithelial ceils in normal and diseased conditions. The relative abundance of Bcl-2 and Bax proteins is critical in directing cells toward or away from apoptosis. The relative abundance of Bcl-2 protein correlates with the survival of prostatic epithelial cells. The age dependent decrease in cell death correlates with a reduced stimulation of Bax protein

Comparación de distintos métodos para evaluar la función androgénica en el adulto mayor / Assessment of androgenic decline in the elderly

Background:The gold standard to assess androgenic status is the measurement of free testosterone by equilibrium dialysis. However, the estimation of free testosterone using formulas based on the law of mass action can be an adequate standard. Aim: To assess androgenic decline in the elderly by different methods. Material and methods: Free testosterone by radioimmunoassay, total testosterone and steroid binding globulin (SHBG) by automated chemiluminiscence system and estradiol by automated electrochemiluminiscence system were measured in 30 male aged 64±5 years (range 60-70), and 25 males aged between 20 and 30 years, as control group; devoid of diseases or drugs that could cause hypogonadism. Free androgen index, free testosterone, biavailable testosterone, and free estradiol were calculated using a formula based on the law of mass action. Results: Fifty seven percent of elderly subjects had hypogonadism, according to calculated free testosterone values. Their total testosterone was on average, 152 nd/dl lower than in young adults, figure that represents a 3.8 ng/dl decline per year. According to total testosterone values, 27 percent of elderly males had gonadal incompetence. The correlations between calculated free testosterone and total testosterone was 0,95 and between calculated free testosterone and measured free testosterone was 0,67. The methods employed overestimated (76.7 percent of hypogonadism when using the free androgen index) or underestimated (27 and 3 percent of hypogonadism, considering total or free testosterone, respectively) the ondrogen decline of the elderly. Among the elderly, 16 or 30 percent of subjects had an absolute hypoestrogenism, based on estradiol or calculated free estradiol values, respectively. On average there was a 20 and 30 percent reduction of estradiol and calculated free estradiol values in the elderly. Conclusions: Calculated free or bioavailable testosterone values should be used to assess androgen decline in elderly men.