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      Diagnóstico e Tratamento do Hipogonadismo Masculino Tardio Translated title: Diagnosis and Treatment of Late-Onset Hypogonadism

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          Abstract

          O hipogonadismo masculino ou hipogonadismo de aparecimento tardio é uma entidade clínica que resulta de alterações do eixo hipotálamo-hipófise-testicular, as quais podem acompanhar as diversas adaptações hormonais e metabólicas associadas ao envelhecimento. Trata-se de um estado clínico sub-diagnosticado que pode repercutir-se na qualidade de vida do indivíduo com défice hormonal. A sua identificação, através do conhecimento das indicações de rastreio e orientação diagnóstica, contribuirá para uma optimização desta qualidade de vida. A dimensão desta questão amplia-se numa era em que a esperança de vida é progressivamente maior. Neste artigo fazemos uma revisão do tema que se pretende contribua para um maior reconhecimento e tratamento desta condição.

          Translated abstract

          Late onset hypogonadism is a clinical entity resulting from changes in the hypothalamic-pituitary-testis axis, which may accompany the various metabolic and hormonal changes associated with aging. This is an under-diagnosed clinical condition which may impact on the quality of life of individuals with hormonal deficit. The identification, through knowledge of the indications for screening and diagnostic guidelines, will help optimize this quality of life. The size of this issue extends in an era where life expectancy is gradually increased. In this article we review the issue in order to contribute to a greater recognition and treatment of this condition.

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          Most cited references73

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          Oral testosterone supplementation increases muscle and decreases fat mass in healthy elderly males with low-normal gonadal status.

          Loss of muscle mass (sarcopenia) leads to frailty in older men. The decline in testosterone over the life span may contribute to this muscle loss. We studied the ability of oral testosterone to prevent muscle loss in older men over a 12-month period. A standard dose (80 mg twice daily) of testosterone undecanoate or placebo was administered for 1 year to 76 healthy men aged 60 years or older. All men had a free testosterone index of 0.3-0.5, which represents a value below the normal lower limit for young men (19-30 years), but remains within the overall normal male range. Measurements of body composition, muscle strength, hormones, and safety parameters were obtained at 0, 6, and 12 months. Lean body mass increased (p =.0001) and fat mass decreased (p =.02) in the testosterone as compared with the placebo-treated group. There were no significant effects on muscle strength. There was a significant increase in hematocrit (0.02%) in the testosterone-treated group (p =.03). Plasma triglycerides, total cholesterol, and low-density lipoprotein cholesterol levels were similar in both groups, but there was a decrease in high-density lipoprotein cholesterol (-0.1 mmol/L) at 12 months in the testosterone group as compared to the placebo group (p = 0.026). There were no differences in prostate-specific antigen or systolic or diastolic blood pressure between the groups. Oral testosterone administration to older relatively hypogonadal men results in an increase in muscle mass and a decrease in body fat.
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            AA2500 testosterone gel normalizes androgen levels in aging males with improvements in body composition and sexual function.

            Testosterone replacement in hypogonadal men improves body composition, mood, and sexual functioning. In this 90-d study, we compared the pharmacokinetics and treatment effectiveness of a topical testosterone gel (AA2500) at two concentrations, 50 mg/d and 100 mg/d, to a testosterone patch and placebo gel in 406 hypogonadal men. Pharmacokinetic profiles were obtained, body composition was measured, and mood and sexual function were monitored. AA2500 treatments resulted in dose-dependent improvements in all pharmacokinetic parameters, compared with testosterone patch and placebo. Mean average concentrations at d 90 T were 13.8, 17.1, 11.9, and 7.3 nmol/liter for 50 mg/d AA2500, 100 mg/d AA2500, testosterone patch, and placebo, respectively. At d 90, the 100 mg/d AA2500 treatment improved lean body mass by 1.7 kg and percentage of body fat by 1.2% to a significantly greater degree than either control treatment. Significant improvements in spontaneous erections, sexual desire, and sexual motivation were also evidenced with the 100 mg/d AA2500 dose in comparison with placebo. Testosterone gel was well tolerated; however, the testosterone patch resulted in a high rate of application site reactions. Overall, AA2500 is an effective, well tolerated treatment for hypogonadism.
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              Endogenous sex hormones and progression of carotid atherosclerosis in elderly men.

              The burden of atherosclerosis especially afflicts the increasing older segment of the population. Recent evidence has emphasized a protective role of endogenous sex hormones in the development of atherosclerosis in aging men. We studied the association between endogenous sex hormones and progression of atherosclerosis in 195 independently living elderly men. Participants underwent measurements of carotid intima-media thickness (IMT) at baseline in 1996 and again in 2000. At baseline, serum concentrations of testosterone (total and free) and estradiol (total and free E2) were measured. Serum free testosterone concentrations were inversely related to the mean progression of IMT of the common carotid artery after adjustment for age (beta=-3.57; 95% CI, -6.34 to -0.80). Higher serum total and free E2 levels were related to progression of IMT of the common carotid artery after adjustment for age (beta=0.38; 95% CI, -0.11 to 0.86; and beta=0.018; 95% CI, -0.002 to 0.038, respectively). These associations were independent of body mass index, waist-to-hip ratio, presence of hypertension and diabetes, smoking, and serum cholesterol levels Low free testosterone levels were related to IMT of the common carotid artery in elderly men independently of cardiovascular risk factors.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                am
                Arquivos de Medicina
                Arq Med
                ArquiMed - Edições Científicas AEFMUP (Porto )
                2183-2447
                February 2010
                : 24
                : 1
                : 13-22
                Affiliations
                [1 ] Hospital de São João
                [2 ] Universidade do Porto
                Article
                S0871-34132010000100003
                b23e8086-3073-45e6-854a-0ac9faea59a3

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Portugal

                Self URI (journal page): http://www.scielo.mec.pt/scielo.php?script=sci_serial&pid=0871-3413&lng=en
                Categories
                MEDICINE, GENERAL & INTERNAL

                Internal medicine
                hypogonadism,male,aging,hipogonadismo,homem,envelhecimento
                Internal medicine
                hypogonadism, male, aging, hipogonadismo, homem, envelhecimento

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