Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 131

Beginning around age 30, serum testosterone levels decrease at a rate of about 1–2% per year. Andropause, or late‐onset hypogonadism, is defined as an age‐related reduction in serum testosterone levels to below the normal range, as determined in young males, with associated sexual symptoms such as erectile dysfunction, decreased sexual thoughts, and decreased morning erections.^30,31 Men may report additional symptoms, such as insomnia, depression, muscle weakness, and irritability, although these symptoms are not used to clinically define andropause.³¹ Late‐onset hypogonadism, or andropause, is relatively rare. A study of community‐dwelling males aged 40–79 across eight European countries found that only 2.1% of men suffered from andropause.³² Some factors affecting andropause, such as obesity and cigarette smoking, may be modifiable.³³

The benefits of treating a low testosterone level in older men without sexual symptoms are not established. Management of andropause consists of testosterone replacement therapy (TRT) and/or lifestyle modifications (weight loss and smoking cessation). Testosterone can be administered in oral, buccal, transdermal, subcutaneous, or intramuscular forms. TRT has been demonstrated in some studies to reduce depression and improve quality of life and sexual function, but in older men specifically, no improvement was noted in measurements of vitality or walking distance.^34,35 Different formulations were not found to significantly affect depression or erectile function, while testosterone gel was demonstrated to be better at improving libido than testosterone delivered either orally or by a patch.³⁴ There have been contradictory data about the risk of adverse cardiovascular events with TRT, and more research is needed in this area. At this time, prostate cancer is considered a contraindication for TRT.³⁶ Men with andropause are at increased risk of secondary osteoporosis and should be screened accordingly.