Ipogonadismo

La sindrome da deficit testosterone, o ipogonadismo maschile, è una sindrome in cui i testicoli non producono abbastanza testosterone. Questo ormone è un androgeno prodotto principalmente nei testicoli e anche nelle ghiandole surrenali. La produzione di androgeni può diminuire con l’età e con alcune condizioni patologiche come l’obesità.

Il testosterone è l’ormone maschile responsabile delle funzioni riproduttive e sessuali. Colpisce la pubertà, la fertilità, la massa muscolare, la composizione corporea, la forza ossea, il metabolismo dei grassi, il desiderio sessuale, l’umore e i processi mentali.

Livelli ridotti di questo ormone possono causare uno spettro di sintomi che vanno dalla diminuzione del desiderio sessuale, minore massa muscolare, disfunzione erettile a fatica o stanchezza, che possono avere un effetto significativo sulla qualità della vita.

Tipi e cause di ipogonadismo

  • L’ipogonadismo primario è causato da un problema ai testicoli. Questo tipo è il più comune nell’infanzia e nell’adolescenza e di solito influisce sullo sviluppo.
  • L’ipogonadismo secondario o ad insorgenza tardiva è causato da un problema della ghiandola pituitaria (regolazione a livello cerebrale della produzione testicolare di testosterone). È una sindrome clinica e biochimica associata all’età avanzata, caratterizzata da sintomi tipici e da una carenza di livelli sierici di testosterone. Può essere dannoso per la qualità della vita e influenzare più sistemi di organi.

Questa sindrome è una grande incognita poiché circa il 70% dei pazienti non è a conoscenza della sua esistenza, tuttavia fino al 52% presenta sintomi compatibili con la malattia, il che porta solo il 22% dei pazienti a consultare uno specialista.

Sintomi

L’ipogonadismo può verificarsi a qualsiasi età. I sintomi saranno diversi a seconda dell’età in cui si sviluppa. I sintomi comuni negli uomini adulti includono:

  • Fatica
  • Vampate di calore
  • Basso desiderio sessuale
  • Disfunzione erettile
  • Cambiamenti d’umore
  • Difficoltà nel mettere a fuoco
  • Difficoltà a dormire
  • Perdita di massa muscolare
  • Diminuzione della densità ossea, osteoporosi
  • Seni ingranditi
  • Perdita di peli sul corpo
  • Infertilità

Dovresti sapere che anche negli uomini con livelli normali di testosterone, questi sintomi possono essere causati da altre condizioni.

Diagnosi

  • In primo luogo, il tuo medico prenderà una dettagliata anamnesi sui sintomi che presenti e la loro evoluzione, oltre a interrogarti su un’altra serie di fatti antecedenti e personali oltre che malattie attuali, fondamentalmente nell’ambito del rischio cardiovascolare e sessuale.
  • Esame obiettivo: utilizzando un esame rettale ed esaminando le tue caratteristiche sessuali secondarie (peli del corpo, massa muscolare).
  • Diagnosi di laboratorio: PSA e bassi livelli di testosterone nel sangue misurato almeno due volte separatamente. Il sangue dovrebbe essere prelevato la mattina prima di colazione. Determina i livelli di testosterone totale e SHBG.

Il medico può indirizzarti a uno specialista in ormoni (endocrinologo) se si sospetta un ipogonadismo. Sulla base dei risultati, il tuo specialista deciderà se sono necessari altri test complementari.

Trattamento dell’ipogonadismo

In primo luogo, sarebbe importante attuare una serie di misure alimentari che controllano malattie di base come l’obesità e il diabete:

  • Perdere peso, modificare la dieta, smettere di fumare e aumentare l’attività fisica possono migliorare la qualità della vita con l’ipogonadismo.
  • Rafforzare e migliorare il controllo del diabete e della sessualità.
  • La terapia ormonale sostitutiva è il trattamento principale per l’ipogonadismo. A seconda del tipo di ipogonadismo vengono utilizzati ormoni diversi. Il suo obiettivo è quello di migliorare la qualità della vita migliorando la sensazione di benessere, la funzione sessuale e i problemi causati sulla sfera cognitiva e funzionale (forza muscolare e ossea) ripristinando i livelli ormonali.

Valutazione della terapia sostitutiva ormonale

Si raccomanda un monitoraggio medico regolare durante il trattamento. Il medico programmerà la necessità di visite con te per valutare se il trattamento sta funzionando, per affrontare i possibili effetti collaterali e durante il trattamento potrebbero essere necessari analisi e test.

Tipi di terapia sostitutiva

I diversi tipi di sostituzione testosterone vengono assorbiti nel corpo in modo diverso e hanno diversi effetti collaterali.

  • Trattamento orale: azione breve, ampiamente usato con pochi o nessun effetto collaterale. Sicuro se utilizzato per un tempo limitato.
  • Trattamento intramuscolare: esistono preparati a breve durata d’azione come il testosterone propionato ogni 2-3 giorni, enantato ogni 2-3 settimane, in cui i livelli ormonali possono essere variabili con i quali i sintomi possono oscillare e ad azione prolungata, undecanoato ogni 3 mesi.
  • Trattamento transdermico (applicato sulla pelle): cerotto o gel di testosterone transdermico per la breve durata. Oppure con serbatoio sottocutaneo (il cerotto che viene posto sotto la pelle e rilascia il farmaco per 5-7 mesi). Come effetti indesiderati, il trattamento a breve termine può irritare la pelle. Il medicinale può essere trasferito accidentalmente a un’altra persona che ne viene a contatto. Il trattamento a lunga durata può causare infezioni della pelle.

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