Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 377

Circulating androgen concentrations decline with ageing. This may contribute to the development of sarcopenia and the decrease in functional status that occurs with ageing (reviewed by Bhasin⁶¹). Whereas androgen replacement therapy (ART) is advocated for men with marked androgen deficiency, there is no consensus for the use of ART in elderly men with less severe ageing‐related declines in androgen concentrations or in elderly women. Studies of androgen replacement have been performed in healthy, older men with androgen deficiency, but although benefits have been seen in muscle mass and, in some cases, strength, as yet there is insufficient evidence regarding improvements in functional status (reviewed by Morley⁶²). Several studies have suggested that there may be benefits from treating older men, particularly if frail, with testosterone therapy. Amory et al.⁶³ gave older men with a mean total testosterone within the normal range 600 mg i.m. testosterone weekly for four weeks before elective knee replacement surgery and found significant increases in the ability to stand postoperatively and trends to improvements in walking and stair climbing, compared with placebo‐treated men. Bakhshi et al.⁶⁴ gave older men in a rehabilitation programme with low‐normal testosterone levels 100 mgi.m. testosterone or placebo weekly and found significant increases in grip strength and the Function Independence Measure after testosterone but not placebo. Chapman et al.⁶⁵ showed a reduced rate of hospitalization over one year in older men and women either undernourished or at risk of undernutrition given a combination of oral testosterone and a nutritional supplement compared with an untreated group. Srinivas‐Shankar et al.⁶⁶ treated older, frail men with low circulating testosterone concentrations with transdermal testosterone or placebo for six months and found improvements in muscle strength and physical function, the latter effects confined to older (≥75 years) and more frail men. These results are not conclusive but justify further studies of testosterone treatment in frail older people.

In women, serum concentrations of testosterone and the adrenal androgens gradually and progressively decline from the decade preceding menopause. Even if testosterone therapy does not increase food intake in older, undernourished people, it may provide functional benefits by treating the associated sarcopenia.