Hormonersatztherapie des Mannes

Abstract

Testosterone is a natural hormone which is essential to maintain physical and emotional wellbeing in men. Male hypogonadism is an endocrine condition of testosterone deficiency with the potential to cause multiple morbidities and psychosocial complaints. The condition can be of primary (testicular), secondary (hypothalamic-pituitary) or so-called functional origin (as a result of inflammatory conditions, obesity or chronic illness). Testosterone deficiency can cause symptoms of sexual nature, insulin resistance, osteoporosis, anemia among others. A replacement of testosterone should not be initiated in case of desired paternity, unclear processes of the prostate, mammary gland, or high hematocrit. Diagnosis and treatment as well as surveillance of the therapy of hypogonadism are clearly regulated by international guidelines and replacement therapy is proven to be effective to ameliorate the above-named complaints when performed according to these guidelines.

Der Hypogonadismus des Mannes resultiert aus einem Testosterondefizit und kann zu verschiedensten körperlichen Beschwerden und psychosozialen Problemen führen. Die Beschwerden aufgrund eines Testosteronmangels sind meist sexueller Natur, können sich aber auch als metabolische Störungen manifestieren. Diagnose, Behandlung und Monitoring der Testosterongabe sind mittlerweile klar durch Leitlinien der Fachgesellschaften beschrieben.

Schlüsselwörter

Testosteron - Hypogonadismus - Androgenmangel

Key words

testosterone - hypogonadism - androgen deficiency

• Literatur

• 1 Dohle GR, Arver S, Bettocchi C. et al. Im Internet: https://uroweb.org/guideline/male-hypogonadism/
• 2 Garvey WT, Mechanick JI, Brett EM. et al. American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesitiy, executive summary Complete Guidelines available at https://www.aace.com/publications/guidelines. Endocr Pract 2016; 22: 842-884
• 3 Bhasin S, Brito JP, Cunningham GR. et al. Testosterone therapy in men with hypogonadism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2018; 103 (05) 1715-1744 . doi: 10.1210/jc.2018-00229
• 4 Zitzmann M. Testosterone deficiency, insulin resistance and the metabolic syndrome. Nat Rev Endocrinol 2009; 5: 673-681
• 5 Camacho EM, Huhtaniemi IT, O’Neill TW. EMAS Group. et al. Age-associated changes in hypothalamic-pituitary-testicular function in middleaged and older men are modified by weight change and lifestyle factors: longitudinal results from the European Male Ageing Study. Eur J Endocrinol 2013; 168: 445-455
• 6 Kelsey TW, Li LQ, Mitchell RT. et al. A validated age-related normative model for male total testosterone shows increasing variance but no decline after age 40 years. PLoS One 2014; 9: e109346
• 7 Zitzmann M. Pharmacogenetics of testosterone replacement therapy. Pharmacogenomics 2009; 10: 1341-1349
• 8 Zitzmann M, Faber S, Nieschlag E. Association of specific symptoms and metabolic risks with serum testosterone in older men. J Clin Endocrinol Metab 2006; 91: 4335-4343
• 9 Traish AM, Zitzmann M. The complex and multifactorial relationship between testosterone deficiency (TD), obesity and vascular disease. Rev Endocr Metab Disord 2015; 16: 249-268
• 10 Corona G, Giagulli VA, Maseroli E. et al. Testosterone supplementation and body composition: results from a meta-analysis of observational studies. J Endocrinol Invest 2016; 39: 967-981
• 11 Morgentaler A, Zitzmann M, Traish AM. et al. Fundamental concepts regarding testosterone deficiency and treatment: International expert consensus resolutions. Mayo Clin Proc 2016; 91: 881-896
• 12 Wu F, Zitzmann M, Heiselman D. et al. Demographic and clinical correlates of patient-reported improvement in sex drive, erectile function, and energy with testosterone solution 2. J Sex Med 2016; 13: 1212-1219
• 13 Snyder PJ, Bhasin S, Cunningham GR. et al. Effects of testosterone treatment in older men. N Engl J Med 2016; 374: 611-624
• 14 Rohayem J, Fricke R, Czeloth K. et al. Age and markers of Leydig cell function, but not of Sertoli cell function predict the success of sperm retrieval in adolescents and adults with Klinefelter’s syndrome. Andrology 2015; 3: 868-875
• 15 Roy CN, Snyder PJ, Stephens-Shields AJ. et al. Association of testosterone levels with anemia in older men: A controlled clinical trial. JAMA Intern Med 2017; 177: 480-490
• 16 Snyder PJ, Kopperdahl DL, Stephens-Shields AJ. et al. Effect of testosterone treatment on volumetric bone density and strength in older men with low testosterone: A controlled clinical trial. JAMA Intern Med 2017; 177: 471-479
• 17 Cunningham GR, Stephens-Shields AJ, Rosen RC. et al. Testosterone treatment and sexual function in older men with low testosterone levels. J Clin Endocrinol Metab 2016; 101: 3096-3104
• 18 Saad F, Aversa A, Isidori AM. et al. Onset of effects of testosterone treatment and time span until maximum effects are achieved. Eur J Endocrinol 2011; 165: 675-685
• 19 Muraleedharan V, Marsh H, Kapoor D. et al. Testosterone deficiency is associated with increased risk of mortality and testosterone replacement improves survival in men with type 2 diabetes. Eur J Endocrinol 2013; 169: 725-733
• 20 Snyder PJ, Bhasin S, Cunningham GR. et al. Lessons from the testosterone trials. Endocr Rev 2018; 39: 369-386
• 21 Corona G, Rastrelli G, Di Pasquale G. et al. Testosterone and cardiovascular risk: meta-analysis of interventional studies. J Sex Med 2018; 15: 820-838
• 22 Rohayem J, Sinthofen N, Nieschlag E. et al. Causes of hypogonadotropic hypogonadism predict response to gonadotropin substitution in adults. Andrology 2016; 4: 87-94