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Science Forum Index » Life Extension Forum » SHBG and andropause
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| kofi |
 Posted: Wed Dec 31, 2003 2:54 am |
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Presse Med. 2002 Nov 23;31(37 Pt 1):1750-9. Related Articles, Links
[Andropause and its management in the aged male]
[Article in French]
de Lignieres B.
Service endocrinologie et medecine de la reproduction, Hopital
Necker 149, rue de Sevres, Paris.
THE "ANDROPAUSE": Also called the "male menopause" or "partial
androgen deficiency of the aging male" etc., corresponds to the age at
which the progressive decrease in androgen activity reaches a pathogenic
threshold. Surveys made in various countries since the seventies
conclude that testosterone blood levels start to decrease after the age
of 25 and that 20 to more than 50% of the male population no longer
benefit from optimal androgen stimulation after the age of 60. THE
CONSEQUENCES OF HYPOANDROGENISM: The subsequent progressive
hypoandrogenism participates in inducing the commonly-observed clinical
symptoms (fatigue, morosity, weight loss, lack of interest in sexual
activity); the most specific of which is the disappearance or
rarification of "automatic" nocturnal or matinal erections. This appears
to influence the prostatic pathology and the frequent cardiovascular
risk factors, which, far more than a problem of erection, is a major
public health issue. A COMPLEX BIOLOGICAL DIAGNOSIS: Added to the
abnormalities in production and transport of testosterone are the
abnormalities in its metabolisation by the target tissues. These
abnormalities are often undetected in present day blood controls and may
explain the elevation in the hepatocyte of SHBG synthesis, the relative
inhibition of GnRH pulses and LH secretion in the hypothalamus and the
pituitary gland and, in the arterial wall (including penile
vascularisation) and the prostate, some of the frequent functional and
histological disorders. In current practice today, the best
approximation of androgen potential is obtained by the comparison of
total testosterone concentrations and SHBG, measurements that require
relatively reliable standardised kits. THERAPEUTIC CHOICE: Optimal
replacement therapy, for some authors, must mimic the physiology of the
young man and above all maintain or reinforce the estrogenic effects of
testosterone, related to its aromatisation into estradiol and supposedly
beneficial for the cardiovascular system and the bone. For other, the
androgenic effects, enhanced by the 5 alpha reduction into
dihydrotestosterone (DHT), should be reinforced in older men because the
estrogenic effects are ineffective on bone and most of the other
targets, and are probably pathogenic for the prostate. This debate is
extremely important since the various formulations of androgens
authorized by the French Medicines agency (AFSSAPS) induce clearly
differing estradiol/DHT plasma ratios.
Publication Types:
* Review
* Review, Tutorial
PMID: 12489320 [PubMed - indexed for MEDLINE] |
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