Provocări actuale în diagnosticul și tratamentul deficitului de testosteron la bărbații de vârstă reproductivă
Cuvinte cheie:
deficit de testosteron, terapie de substituțiecu testosteron, infertilitate masculină, hipogonadism, vârstă fertilăRezumat
Actualmente, un număr tot mai mare de bărbați tineri și de vârstă mijlocie sunt în căutarea tratamentului pentru simptomele legate de nivelul scăzut de testosteron, care includ depresia, oboseala cronică, libidoul scăzut, disfuncția erectilă și/sau infertilitatea. În situațiile în care conceperea unui copil nu este un obiectiv pe termen scurt sau mediu, prezervarea funcției reproductive necesită a fi considerată în contextul tratamentului oferit. Având în vedere caracterul adeseori idiopatic al deficitului de testosteron, în special pentru bărbații de vârstă reproductivă, alegerea metodei de tratament devine și mai dificilă, în contextul în care evidența științifică și gradul de recomandare a diverselor tratamente sunt slabe. A fost efectuată analiza literaturii contemporane, cu utilizarea principalelor baze de date, inclusiv PubMed, Hinari, SpringerLink și Scopus (Elsevier). S-a constatat că o treime dintre bărbații infertili cu vârsta sub 50 de ani sunt hipogonadali. Corelarea rezultatului spermogramei cu nivelul de testosteron a identificat un deficit la 16,7% dintre bărbații cu azoospermie obstructivă, 45% dintre bărbații cu azoospermie non-obstructivă, 42,9% dintre bărbații cu oligozoospermie și/sau astenozoospermie și 35,3% dintre bărbații cu parametri normali ai spermei. Terapia de substituție cu testosteron, deși eficientă în abordarea majorității simptomelor hipogonadismului, are efecte negative asupra funcției testiculare. Consilierea ar trebui să includă o discuție amănunțită a riscurilor și beneficiilor, cu accent pe supresia spermatogenezei pentru bărbații de vârstă reproductivă care doresc să-și mențină potențialul de reproducere.
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