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Testosterone is the male sex hormone and is formed in the testes. It has important functions in the various phases of life. In unborn babies, it ensures the development of the male sex organs. In puberty, it is responsible for masculinization. In adults, finally, it controls the sexual function and maintains a man's phenotype, i.e. the typical male characteristics.
Testosterone Deficiency Syndrome (Hypogonadism) and Metabolic Syndrome
Hypogonadism is a clinical syndrome resulting from a failure of the testes to produce physiological levels of testosterone (androgen deficiency), sperm, or both, because of disruption of one or more levels of the hypothalamic-pituitary-gonadal axis1.
Hypogonadism can occur in men of any age, however, there is a progressive decline in testosterone levels as men age. Late-onset hypogonadism (LOH; age-related hypogonadism) is a clinical and biochemical syndrome associated with advancing age and characterized by symptoms and a deficiency in serum testosterone levels below the young healthy adult male reference range of approximately 10 – 35 nmol/L (300 – 1000 ng/dL) 2,3.
Unlike the clearly defined decrease in hormone levels associated with female menopause, the decline in androgen levels with advancing age in men is gradual and variable, and the late-onset hypogonadism is more appropriate than the colloquial terms “male menopause” or “andropause” to refer to the annual decrease in testosterone levels of 0.5% to 2% which occur with advancing age, independent of chronic conditions associated with aging4.
Testosterone deficiency (TD) afflicts approximately 30% of men aged 40-79 years, with an increase in prevalence strongly associated with aging and common medical conditions including obesity, diabetes, and hypertension. A strong relationship is noted between TD and metabolic syndrome, although the relationship is not certain to be causal5.
Testosterone Deficiency and Metabolic Syndromes
Testosterone is essential for organ development and maintains sexual function or male reproductive and it plays significant role for men’s cycle life. Actually, the last few years, many studies shown that the decrease in testosterone levels causes a decrease in bone density and an increased incidence of bone fractures, decreased red blood cells, decreased muscle mass and increased fat, depression and mood disorders. The most serious medical condition is the increased risk of metabolic syndrome and coronary heart disease that eventually leads to death.
According to the National Health Institute, USA, metabolic syndrome is the name for a group of risk factors that raises the risk for heart disease and other health problems, such as diabetes and stroke. Based on medical studies, obviously, having any one of these risk factors isn't good. But when they're combined, they set the stage for serious problems. These risk factors double the risk of blood vessel and heart disease, which can lead to heart attacks and strokes. They increase risk of diabetes by five times, if the person is suffering from metabolic syndrome after 5-10 years6.
The International Diabetes Federation (IDF) states that these risk factors are abdominal obesity (> 90 cm for men and > 80 cm for Asian women), increased fasting blood sugar levels (> 100 mg / dl), increased triglycerides (> 150 mg / dl) and HDL reduction (< 40 mg / dl for men and, < 50 mg / dl for women) and high blood pressure (> 130/85 mmHg).
A man is diagnosed with metabolic syndrome if he has at least three risk factors7. First, excess fat in the abdominal area is a greater risk factor for heart disease than excess fat in other parts of the body, such as the hips. Second, high blood pressure or hypertension. If this pressure rises and stays high over time, it can damage the liver and cause plaque buildup. Third, high blood sugar fasting. This condition is an early sign of diabetes.
If a man suffering from metabolic syndrome, then the possibilities to suffers hypogonadism is triple and the prevalence rate of deaths increased by about one and a half times.
In addition, the decreasing of testosterone level in man body is related also with age. This decline is about 2% – 3% per year. At the age of 40 years, the testosterone levels to approximately 65% – 70% and at the age of 60 years and above about 45% – 50% of the age of 25 years old.
Hormone-replacement therapies can help men with testosterone deficiency, improve their mental and physical well-being, sexual satisfaction, and quality of life. This is also a way of preventing possible sequels such as osteoporosis.
In such hormone-replacement therapies, the lack of testosterone is made up from outside. One of hormone replacement therapy with injection is Testosterone Undecanoate.
The reversible effect between hypogonadism, metabolic syndrome and heart disease and blood vessels has been proven both experimentally and clinically. Therefore, to reduce the risk of death from heart disease for men with hypogonadism, either accompanied or who have metabolic syndrome, testosterone hormone replacement therapy is essential to cut the chain of these reversible effect. A man who suffers hypogonadism, will also suffers blood vessel and heart disease8.
Study shown that testosterone therapy can improve each component of metabolic syndrome, reduced fat mass, improve muscle mass, lowers blood sugar levels, improve insulin sensitivity, improves lipid so that the LDL cholesterol and triglyceride can decrease and HDL increased, can reduce blood pressure both systolic and diastolic9.
1. Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS, Montori VM; Task Force, Endocrine Society. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010 Jun;95(6):2536-59.
2. ISA, ISSAM, EAU, EAA and ASA recommendations: investigation, treatment and monitoring of late-onset hypogonadism in males. Wang C, Nieschlag E, Swerdloff RS, Behre H, Hellstrom WJ, Gooren LJ, Kaufman JM, Legros JJ, Lunenfeld B, Morales A, Morley JE, Schulman C, Thompson IM, Weidner W, Wu FC. Aging Male. 2009 Mar;12(1):5-12.
3. Larsen P, Kronenburg H, Melmed S, et al. William's Textbook of endocrinology, reference values. Philadelphia, PA, USA: Saunders; 2002
4. Seftel AD. Male hypogonadism. Part I: Epidemiology of hypogonadism. Int J Impot Res 2006; 18(2): 115-20
6. National Health Statistics Reports No.13, May 5, 2009: Prevalence of Metabolic Syndrome Among Adults 20 Years of Age and Over, by Sex, Age, Race and Ethnicity, and Body Mass Index: United States, 2003–2006, by R. Bethene Ervin, Ph.D., R.D., Division of Health and Nutrition Examination Surveys.
7. Bodie J et al. J Urol 2003; 169:2262–2264.
8. Diabetes UK, personal communication. 27/02/09.
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