Testosteron im Alter – ein Update

Zusammenfassung

Eine der Menopause vergleichbare Andropause gibt es nicht. Beim Mann kommt es mit zunehmendem Alter allenfalls zu einem graduellen Abfall der Testosteronproduktion. Da nach den Schwellenwerten aktueller Leitlinien ein Androgendefizit bei einem Großteil der über 80-jährigen Männer vorläge, wirft dies insbesondere in der Geriatrie die Frage nach therapeutischen Konsequenzen auf. In zahlreichen Studien korrelierten niedrige Testosteronwerte mit einem erhöhten Mortalitäts- und Morbiditätsrisiko. Ein Kausalitätsgefüge für diese Assoziation konnte bislang jedoch nicht belegt werden, sodass praktisch-klinische Schlussfolgerungen verfrüht sind. Dem im Alter von über 60 Jahren neu festgestellten Adrogendefizit wird bei gleichzeitigem Vorliegen bestimmter Symptome ein Krankheitswert als sogenannter Late-onset-Hypogonadismus (LOH) beigemessen. Die für die Diagnose notwendigen Symptome waren bislang weit gefasst. Auf dem Boden aktuellster Forschungsarbeiten (EMAS-Studie) muss der LOH jedoch eingeschränkt als sexualanamnestisch akzentuiertes Syndrom mit für die Geriatrie nachgeordneter Relevanz gesehen werden. In Assoziationsstudien findet sich ein vager Zusammenhang zwischen Androgendefizit und Gebrechlichkeit (Frailty) bzw. dem assoziierten geriatrischen Syndrom der Sarkopenie, d. h. einer Abnahme von Muskelmasse und Muskelkraft. Therapeutische Ansätze, Sarkopenie durch Testosteronsupplementation zu behandeln, zeigten nur eingeschränkten Erfolg. Mehr noch: Aufgrund des erhöhten Auftretens kardiovaskulärer Ereignisse unter Testosteronsupplementation in der TOM-Studie muss bei der Verordnung von Testosteron aktuell zu besonderer Vorsicht geraten und beim älteren Mann mit kardiovaskulärer Anamnese für ein Moratorium der Testosterongabe plädiert werden.

Abstract

Contrasting the relatively abrupt hormonal changes during female menopause, male reproductive function gradually declines during aging. This leads to the formal diagnosis of androgen deficiency in many apparently healthy 80-year-old men, when conventional thresholds are applied, and consequently to the question of androgen substitution in geriatric medicine. Although many clinical studies have documented a correlation between low plasma testosterone levels and mortality a clear causal relationship – which would imply immanent substitution therapy – has not been demonstrated. With this in mind, the diagnosis of late-onset hypogonadism (LOH) should only be made when testosterone-deficiency related symptoms concur with low testosterone levels. Which exact symptoms justify the diagnosis of LOH, however, is not sharply defined. Using criteria defined in the recent EMAS study, LOH might even be an over-diagnosed entity without huge relevance in geriatrics. Low testosterone levels are associated with frailty, but testosterone supplementation has only shown limited effects on age-related sarcopenia. Moreover: the increased incidence of cardiovascular events in the TOM study should be a caveat and lead to a moratorium for uncritical testosterone supplementation in aging men with cardiovascular diseases.

Schlüsselwörter

Testosteron - Androgendefizit - Late-onset-Hypogonadismus - Gebrechlichkeit - Sarkopenie

Keywords

testosterone - androgen deficiency - late-onset-hypogonadism - frailty - sarcopenia

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