Androgen deficiency is a deficiency of testosterone (male sex hormone) in a man’s body. In adolescence, it is manifested by a delay in puberty and the absence of secondary sexual characteristics. In adulthood, it causes a decrease in sexual desire, erection, and a decrease in hair growth in androgen-dependent zones. Leads to a disorder of sexual life, infertility, personal psychological trauma. It is diagnosed according to hormonal tests. Treatment involves the appointment of hormone replacement therapy.
E29.1 Testicular hypofunction
Androgen deficiency syndrome in men occurs at different age periods of life: from puberty to adulthood. Age-related androgen deficiency is caused by an insufficient amount of androgens in the male body. This condition is a natural age-related change, and its first symptoms begin to manifest after 50 years, early androgen deficiency and symptoms of premature aging manifest themselves in 40-45 years. Androgen deficiency occurs due to a decrease in testosterone production, which affects all organs and systems.
Testosterone is the main male hormone. He is responsible for the formation of male behavior and secondary sexual characteristics (facial hair growth, voice coarsening). Growth and development of the genitals, muscle gain, erection are impossible without testosterone. Adipose tissue in men is distributed completely differently from that in women; spermatogenesis and the development of the skeleton according to the male type also completely depend on the level of testosterone in the body.
The pituitary gland and hypothalamus produce hormones, thanks to which testosterone is produced in the testicles by Leiding cells. Both of these processes are interdependent and are regulated depending on the need and on the percentage concentration of each hormone. All testosterone is in the blood in active and inactive fractions; the hormone located in active fractions is responsible for the main actions of testosterone.
The exact cause of androgenic aging is unknown, but of all the theories that clinical andrology has to date, several are the most likely. Age-related atherosclerotic changes in the body lead to a decrease in blood supply to the testicles, which affects the size and condition of the Leiding cells – they become less active. According to the same theory, apoptosis of Leiding cells occurs at a certain time, that is, their programmed death.
In the hypothalamus and pituitary gland, dystrophic and sclerotic changes also occur with age, which leads to violations of the regulation of the testosterone production process. The theory that hereditary predisposition may play a major role in the development of early androgen deficiency is confirmed by the fact that the activity of hormone-producing tissue is genetically determined.
Symptoms of androgen deficiency
Physiological aging due to a decrease in testosterone levels in the blood is manifested primarily by the reproductive system: sexual desire (libido) decreases, weak erection and lack of ejaculation after sexual intercourse are possible, in some men the orgasm becomes less vivid. All this leads to physiological age-related infertility, if the androgen deficiency is not premature.
On the part of other organs and systems, the severity of symptoms depends on the degree of hypogonadism. Most men develop vegetative-vascular disorders: unrelated to the work of the adrenal glands, fluctuations in blood pressure, hot flashes, a feeling of lack of air, dizziness and unreasonable redness of the skin of the neck and upper half of the chest.
Psychoemotional disorders are also increasing, which is manifested by rapid fatigue, sleep disorders, irritability and depression. In men, the volume of muscle mass decreases, sometimes it is replaced by fat, while adipose tissue is deposited everywhere, and not only in the subcutaneous layer. In some men, the mammary glands slightly increase in size, and the growth of hair in the facial area decreases. A more serious manifestation of hypogonadism is a decrease in bone density (osteoporosis), which can cause frequent fractures.
A decrease in testosterone in the blood increases the likelihood of prostate cancer, the likelihood of diabetes mellitus, and also leads to the progression of vascular atherosclerosis with a high risk of cerebral vascular stroke and myocardial infarction.
Patient complaints, features in appearance and determination of testosterone concentration are the main diagnostic criteria. Questionnaires, with the help of which it is much easier to assess the patient’s complaints, are also more accurate, since the patient may not speak out loud about his problems. The AMS questionnaire determines the severity of symptoms in points, but additionally it is necessary to undergo a laboratory examination to identify the level of androgen deficiency.
In the laboratory, blood serum is examined for the content of total testosterone and biologically active testosterone. They will conduct a general and biochemical blood test, as well as determine the amount of globulin binding sex steroids (GBSS).
Blood sampling to determine the main androgen in the serum is performed in the morning and on an empty stomach, since its concentration is maximum in the morning. In general, testosterone in a man’s body can be in three states, most of all testosterone associated with albumins and serum globulins (98-99%) and the remaining 1-2% accounts for free testosterone. The connection with albumins is unstable, so the hormone is partially active, while globulin is completely associated with testosterone, so the biological activity of the hormone is completely suppressed. It is free active testosterone that regulates the above functions and it is by its concentration that the degree of androgen deficiency is determined.
The normal indicator of total testosterone in the blood serum is at least 12 nmol / l, while immediately after receiving the results, we can talk about the correspondence of the preliminary diagnosis and reality. But in some cases, the level of total testosterone is within the normal range, and the content of free hormone is reduced due to its excessive binding to blood proteins. Then they resort to the study of the amount of free testosterone in the blood serum.
All men who have a chance of androgen deficiency also need to undergo a bone density examination (densitometry) and other studies, the exact list of which will be determined by the attending andrologist.
Treatment of androgen deficiency
The main method of correction of androgen deficiency is substitution therapy using various testosterone preparations. Sometimes they resort to stimulating the production of their own testosterone with the help of chorionic gonadotropin.
Replacement therapy is carried out only after the exclusion of prostate cancer. Therefore, it is important to undergo early laboratory diagnostics upon reaching the age of 40-45. Since the lack of testosterone increases the likelihood of prostate carcinoma, and the initiated replacement therapy only worsens the patient’s condition, although with a normal level of testosterone in the blood serum, the probability of developing prostate carcinoma is several times lower. In order to exclude cancer of the prostate gland, the level of prostate-specific antigen is determined in the laboratory, and if necessary, a more detailed examination is carried out for the presence of cancer cells.
Replacement drugs must be taken for life, since the ovaries no longer produce testosterone, patients need to periodically monitor the state of the prostate gland and determine the level of PSA.
The effectiveness of treatment becomes noticeable after the accumulation of the necessary concentration of testosterone in the body and the elimination of manifestations of its shortcomings. At the same time, substitution therapy is completely safe, has a minimum of side effects and allows men, especially with premature androgen deficiency, to lead a habitual lifestyle and remain active.
There are several ways to introduce testosterone into the human body. There are patches, creams or gels – in this case, testosterone comes transdermally, subcutaneous implants are drugs of prolonged action, which is very convenient, since there is no need to monitor the daily intake of testosterone. The classic forms are tablet forms for oral administration and oil solutions for intramuscular injections.