Terapia de substitutie cu testosteron (TRT)

Astazi vorbim despre terapia de substitutie cu testosteron, prescurtat si TRT (de la Testosterone Replacement Therapy).

   In primul rand, ce anume este TRT-ul?

   Testosteronul este principalul hormon masculin si este responsabil de cele mai importante schimbari ale organismului unui barbat, insa acesta nu ramane mereu la niveluri mari, scazand odata cu inaintarea in varsta. Astfel, cand ajungem la o varsta la care productia corpului de testosteron este prea mica pentru a functiona corect, putem apela la TRT, adica corpul nostru va primi testosteron artificial din exterior, folosindu-se de obicei injectii cu testosteron entanat. 

   Acum, ce inseamna corect ?! Este o intrebare foarte buna: foarte multi oameni functioneaza pe nivele foarte mici, minime de testosteron, din cauza varstei foarte inaintate, ori a altor dereglari hormonale ce s-au intamplat pe parcurs. Acestia pot functiona normal, perfect din punctul de vedere al unui medic, mai bine spus, POTI TRAI si pe nivele scazute de testosteron, dar multi dintre noi vrem mai mult. Pentru multi dintre barbati nu este acceptabil ca odata ce ai ajuns la o varsta sa te simti obosit, prost dispus, sa vezi cu ochii tai cum te ofilesti, nu mai ai forta si nu mai poti face nimic din ce iubeai. Multi se resemneaza, isi spun ca asa este cand imbatranesti, spunand tuturor povesti despre ei si cum era „cand eram tanar fecior” (hai ca sigur stiti melodia asta, e imposibil sa nu o stiti). In mare parte, problemele astea sunt date de nivelurile mici de testosteron si pot fi corectate. Orice barbat cu varsta de peste 40 de ani poate merge la un medic specialist, care in urma unei consultatii, sa il puna pe terapie de substitutie cu testosteron, daca asta isi doreste. Terapia iti asigura in general un saptamanal de 200-300 mg de testosteron, ceea ce este foarte bine si suficient chiar cat sa te simti din nou ca la 20 de ani. Mai jos aveti un exemplu de cum arata un nivel natural normal de testosteron, in functie de varsta, la femei si barbati.

   Am vorbit destul despre asta, sa intram in subiectul de astazi, este sanatoasa aceasta terapie? Din punct de vedere psihic, e clar ca un nivel normal de testosteron te va face sa te simti din nou tanar, te va ajuta sa iti recapeti forta, chiar sa o cresti, crescandu-ti si muschii si permitandu-ti sa devii din nou definit, caci cu cat inaintam in varsta este mai greu sa ramanem in forma fara ajutor chimic.

   S-au facut nenumarate studii pe aceasta tema si va voi prezenta imediat rezultatul acestora, dar mai intai, imi doresc sa le enumar, cat sa va spun si care este esantionul pe care s-a facut testarea, ca sa va faceti o idee:

1)      Valdermasson et al. (1987) – no placebo group, 10 subjects, 9 months, late onset hypogonadism (LOH) w/ baseline T of 1.8 nmol/l receiving TE 250 mg/3–4 weeks
2)      Rebuffé-Scrive et al. – no placebo group, 11 subjects, 1.5 months, mean age 42y, overweight/obese subjects, mean baseline T 13.8nmol/l, receiving TU 120–160 mg/day
3)      Forbes et al. (1991) – no placebo group, 7 subjects, 4 months, healthy, normal T levels, receiving TE 42 mg/kg/week
4)      Marin and Krotkievski et al. (1992) – no placebo group, 11 subjects, 1.5 months, mean age 42y, obese subjects, low T at 13.8 nmol/l, receiving TU oral 160 mg/day
5)      Marin and Krotkievski et al. (1996) – no placebo, 8 subjects, 3 months, mean age 42y, obese, low T at 14.1 nmol/l on T gel 250 mg/day
6)      Brodsky et al. (1996) – no placebo, 5 subjects with late onset hypogonadism (LOH) and T-levels of only 3.7 nmol/l on TC 3 mg/kg/2 weeks
7)      Katznelson et al. (1996) – no placebo, 29 subjects, 13 months, mean age 57, LOH w/ testosterone levels of 6.4 nmol/L on TE or TC 100 mg/week
8)      Wang et al. (1996) – no placebo, 67 subjects, for 6 months, LOH w/ starting T levels of 4.1 nmol/l taking T sublingually at 15 mg/day
9)      Zgliczynski et al. (1996) – no placebo, 22 subjects, 12 months, mean age 58.5y, normal elderly men with very low T (4.3 nmol/l) taking TE 200 mg/2 weeks
10)   Bhasin et al. (1997) – no placbeo, 7 subjects, 2.5 months, mean age 34.7y, LOH at initially 2.5 nmol/l receiving TE at a dosage of 100 mg/week
11)   Tan et al. (1998) – no placebo, 11 subjects, 4 months, mean age 33.3y, LOH w/ initially 5.5 nmol/l receiving TE at a dosage of  250 mg/4 weeks
12)   Brill et al. (2002) – no placebo, 10 subjects, 1 month, mean age 68.1y, but T-levels of 15 nmol/l treated with T patches at 5 mg/day
13)   Minnemann et al. (2007) – no placebo 25 subjects, mean age 57y w/ LOH and initial T levels of pretty high 14.3 nmol/l receiving TU 1000 mg/12 weeks from week 6
14)   Naharci et al. (2007) – no placebo, 24 subjects, 6 months, mean age 20.7y, low T at 5.7 nmol/l treated with mixed ester at 250 mg/3 weeks
15)   Saad et al. (2007) – no placebo, 28 subjects, 13 months, LOH with erectile dysfunction (ED), low  T at initially 7.5 nmol/l treated with  TU at 1000 mg/12 weeks from week 6
16)   Saad et al. (2008) – 27 subjects, 9 months, mean age 60y LOH with ED and initial T levels of 7.5 nmol/l treated with TU 1000 mg/12 weeks from week 6 or T gel 50mg/day
17)   La Vignera et al. (2009) – no placebo, 7 subjects, 3 months, mean age 58y, LOH with MetS and unknown baseline T levels treated with T gel 50 mg/day
18)   Moon et al. (2010) – no placebo, 133 subjects, 6 months, mean age 54y baseline T of 8.6 nmol/l treated with TU at 1000 mg/12 weeks from week 6
19)   Permpongkosol et al. (2010) – no placebo, 161 subjects, 13.5 months, mean age of 60.4y and LOH consulting urological center w/ T at 9.4 nmol/l on TU 1000 mg/12 weeks from week 6
20)   Garcia et al. (2011) – no placebo, 29 subjects, treated for 25.5 months,  mean age 55.5y, LOH and diabetes, no baseline T available, treated with TU 1000 mg/12 weeks from week 6
21)   Schwarz &Willix (2011) – no placebo, 56 subjects, 18 months, mean age 52.3y, overweight or obese with baseline T of 15 nmol/l receiving TC 80–200 mg/week + diet + training
22)   Arafa et al. (2012) – no placebo, 56 subjects, 12 months, mean age 55.5y w/ T2DM and unknown baseline T treated w/ TU 1000 mg/12 weeks from week 6
23)   Schroeder et al. (2012) – no plaebo 29 subjects, 4 months, mean age 71y, baseline T of 13.1 nmol/l treated with T patch 5 or 10 mg/day
24)   Jo et al. (2013) – no placebo, 18, 26.8 months, mean age 35.9y and suffering from Klinefelter syndrome, with low T at 3.1 nmol/l at baseline treated w/ TU 1000 mg/12 weeks from week 6
25)   Ko et al. (2013) – no placebo, 246 subjects, 14.7 months, mean age 58.5y  treated w/ TU 1000 mg/12 weeks from week 6
26)   Rodriguez-Tolrà et al. (2013) – no placebo, 50 subjects, 12 months, mean age 59.1y, LOH, mean T at baseline 10.2 noml/l treated w/ T gel 25–100 mg/day
27)   Saad et al. (2013) – no placebo, 255 subjects, 60 months, mean age 58y, mixed urological population, low T at 10.0 nmol/l treated with TU 1000 mg/12 weeks from week 6
28)   Tirabassi et al. (2013) – no placebo, 15 subjects, 18.5 months, mean age of 55.7y, LOH w/ baseline T levels of 5.2 nmol/l on TU 1000 mg/12 weeks from week 6
29)   Zitzmann et al. (2013) – no placebo, 1438 subjects, 10.5 months, mean age 49.2y, LOH w/ baseline T levels of 9.6 nmol/l on TU 1000 mg/12 weeks from week 6
30)   Francomano et al. (2014) – no placebo, 20 subjects, 60 monhts, mean age 57.5y, MetS and basline T of 8.3 nmol/l on TU 1000 mg/12 weeks from week 6
31)   Pexman-Fieth et al. (2014) – 669 subjects, 6 months, 53y, LOH on  T gel 50, 75 or 100 mg/day
32)   Yassin et al. (2014) – no placebo, 261 subjects, 54 months, mean age 59.5y, LOH w/ baseline T levels of 7.7 nmol/l treated w/ TU 1000 mg/12 weeks from week 6
33)   Zitzmann et al. (2014) – no placebo, 381 subjects, treated for 60 months, mean age 42.6y w/ LOH and low T at 5.2 nmol/l on TU 1000 mg/12 weeks from week 6

      Multe studii, nu? Vorbim de 4513 pacienti, cu o varsta medie de 51.7 ani (+ sau – 6.1), care au fost testati, iar rezultatul a fost acelasi, in mare parte: Terapia de substitutie cu testosteron a fost asociata cu o reducere a greutatii corporale si a circumferintei taliei.

      S-a constatat in final o reducere semnificativa a grasimii corporala si o crestere a masei musculare pure, cat si o reducere a rezistentei la insulina si a glicemiei.    

     Multi probabil va intrebati si ce impact a avut TRT-ul asupra colesterolului, iar studiile prezentate mai sus ne raspund si la aceasta intrebare: Terapia de Substitutie cu Testosteron a fost asociata cu imbunatatire a profilului lipidelor pentru toti participantii la studii, adica o reducere a colesterolului total si o crestere a colesterolului bun, prescurtat si HDL.

      Intr-un final, putem trage bara si sa spunem ca TRT-ul a fost sanatos pentru acesti oameni, caci aveau nevoie de el, productia lor naturala de testosteron era prea mica, iar dozele de testosteron pe care le-au primit au fost moderate spre mici. Este normal ca daca se face abuz sa apara mai multe efecte negative, decat pozitive, dar cata vreme urmam indicatiile medicului care ne va pune pe TRT, nu vom avea decat de castigat!

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