Andropause Androgen Deficiency in Aging Male ADAM.

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Presentation transcript:

Andropause Androgen Deficiency in Aging Male ADAM

physiology GnRH LH testosterone Pulsatile secretion Diurnal, Annual, Irregular Fluctuation

Plasma concentration Highest Mor ning Afternoon Fall Spring 18 y.o After 50 y.o Lowest

تغیرات فیزیولوژیک با افزایش سن GnRH pulse generator محو شدن LH pulsatility محو شدن basal LH بالا رفتن FSHبالا رقتن SHBG بالا رفتن کاهش تولید تستسترون وانواع آن بعد ازپنجاه سالگی steroidogenesis کاهش توانایی سلول های لیدیگ در fecundity کاهش قدرت

عوارض پیری در مردان (strength and stamina) کاهش قدرت (thought and cognition) کاهش و کند شدن روند تفکر ضعف و خستگی و بی حالی بروز افسردگی Potency and libido کاهش کاهش حجم عضلات افزایش میزان چربی (leptin) افزایش میزان لپتین افزایش پوکی استخوان و شکستگی لگن تا کنون مشخص نشده است کدام یک از عوارض فوق ناشی از کمبود تستسترون است.

درمان با تستسترون Increase in libido Enhanced quality of erection Increase in muscle mass and strength Increase in bone mineral density Cognition Function Decrease in fat mass

Assayes 1-total tesrtostrone (free+Alb +SBG bound) 2-bioavialable testostrone(free+Alb bonde) 3-free testodtorone 4-salivary testostorone

Questionnaires for ADAM 1-st,Louise university ADAM 2-aging male survey AMS 3-Massachussettes,Male aging study risk factors symptoms

Contraindication of androgen therapy Absolute 1-prostatic cancer 2-male breast cancer 3-sensitivity to ingredinents 4-preexisting polycythemia Relative 1-BPH 2-high PSA 3-obstractive sleep apnea 4-Dz cause edema (eg.CHF,RF,Hepatic failoure)

Risk of androgen therapy 1-gynecomastia 2-acne 3-sleep apnea 4-polycythemia( HCT >55%) heart failure, sleep apnea, storke 5-effect on BPH ? 6-Effect on CV Dz ? 7-Hepatic side effects (hemorrhagic liver cyst,cholestatic hepatitis,hepatocellolar adenoma and adenocarcinoma,peliosis hepatitis)

Who needs RX or W/U Endocrine society on andropause consensus conference ( ) suggests : Serum testostorone <200ng/dl needs RX Serum testostrone ng/dl needs bioavailable testostoerone

Follow up 4/year then 2/year 1-clinical response 2-DRE 3-blood test for testostorone Hb,HCT PSA Lipid profile LFT

Preparations 1-oral 2-injectable 3-patches 4-gels

Research 1-buccal 2-inhalation 3-selective androgen receptor modulator

تستسترون در زنان. اطلاعات بسیار کم است. تستسترون از حدود چهل سالگی کم می شود نوع آزاد در زنان منوپوز که استروژن می گیرند بسیار کم می شود. در بعضی از زنان درمان با تستسترون منجر به افزایش چشم گیر لیبیدو می شود.