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ENVEJECIMIENTO MASCULINO Y HORMONAS SEXUALES
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ENVEJECIMIENTO MASCULINO Y HORMONAS SEXUALES

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Existe cierta evidencia del papel que desempeña la testosterona en la aparición de signos clínicos y síntomas asociados al envejecimiento masculino; sin embargo, la importancia clínica entre la edad y el hipogonadismo es aún poco clara.
vermeulen9.jpg Autor:
Alex Vermeulen
Columnista Experto de SIIC
Artículos publicados por Alex Vermeulen
Recepción del artículo
13 de Enero, 2004
Aprobación
3 de Febrero, 2004
Primera edición
28 de Junio, 2004
Segunda edición, ampliada y corregida
7 de Junio, 2021

Resumen
El envejecimiento masculino se acompaña de deterioro progresivo de los niveles de testosterona plasmática y, además, de una serie de signos y síntomas que recuerdan la sintomatología del hipogonadismo en hombres jóvenes, por lo que parece razonable aceptar que los bajos niveles de testosterona desempeñan un papel en el envejecimiento. Este último, sin embargo, tiene origen multifactorial, con niveles descendidos de hormona de crecimiento, sedentarismo relativo, obesidad y resistencia a la insulina, condiciones que desempeñan un papel especial. De esta forma, no sorprende que la correlación entre los síntomas y los niveles de testosterona se considere débil, si bien estadísticamente significativa. El papel exacto que desempeña el hipogonadismo relativo en esta sintomatología sigue siendo, a pesar de todo, difícil de definir, y el suplemento con andrógenos solo debe ser considerado en presencia de ambas condiciones: síntomas evidentes y niveles de testosterona por debajo de lo normal. La experiencia con suplemento de andrógenos en hombres de edad avanzada es aún muy limitada y existen muy pocos estudios que incluyan investigaciones por períodos mayores a un año. En relación con los hallazgos de estas investigaciones es posible concluir, con prudencia, que el tratamiento con andrógenos en hombres de edad avanzada puede tener algún efecto beneficioso sobre la masa muscular, la grasa corporal, la libido y posiblemente en la masa ósea; con el logro de mejores resultados en presencia de niveles basales de testosterona más reducidos. De todas formas, los efectos beneficiosos en los parámetros clínicos de importancia, como caídas, fracturas, infarto de miocardio, no han sido reconocidos hasta el momento. Los riesgos a largo plazo y la proporción de beneficios permanecen poco conocidos; si bien el tratamiento parece ser seguro, se sugiere la realización de una rigurosa vigilancia de los efectos adversos, en particular de la próstata.

Palabras clave
Varones, envejecimiento, andrógenos, testosterona, hipogonadismo, deficiencia androgénica parcial en el envejec, deficiencia androgénica parcial en el envejec


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Abstract
Aging in males is accompanied on the one hand by a progressive decline of plasma testosterone levels and on the other hand by a series of signs and symptoms reminiscent of the symptomatology of hypogonadism in young males. It seems reasonable to assume a role of low testosterone levels in this symptomatology. The latter, however has a multifactorial origin, with decreased growth hormone levels , relative sedentarism, obesity and insulin resistance playing a role. Hence it is not surprising that correlations between symptoms and testosterone levels are generally weak, although often statistically significant. The exact role of the relative hypogonadism in this symptomatology remains, nevertheless still difficult to define and androgen supplementation should only be considered in the presence of both evident symptoms and subnormal testosterone levels. Experience with androgen substitution in elderly males remains still very limited and very few studies covered a period exceeding one year. From these studies it can cautiously be concluded that androgen treatment of elderly men may have some beneficial effects on muscle mass, body fat, libido and possibly bone mass, the more evident beneficial effects refer to the lower basal testosterone levels. However, beneficial effects on clinically relevant parameters such as falls, fractures heart infarction or mortality have, so far, not been reported. The long term risks and benefits ratio remains largely unknown, although so far, treatment seems to be rather safe, but careful monitoring for side effects, in particular at the level of the prostate, remains mandatory.

Key words
Males, aging, androgens, testosterone, hypogonadism, PADAM (partial androgen deficiency of the agi, PADAM (partial androgen deficiency of the agi


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Especialidades
Principal: Urología
Relacionadas: Diagnóstico por Laboratorio, Endocrinología y Metabolismo, Geriatría



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