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Intervista al Prof Della Camera sull' ipogonadismo definito anche come carenza di testosterone. La carenza di testosterone e' una patologia difficilmente diagnosticata perche spesso paucisintomatica ( pochi sintomi) .Spesso viene diagnosticata per le sue correlazioni con la disfunzione erettile ( impotenza) ma nel video viene spiegato come la carenza di testosterone ha effetti a tutto tondo sull organismo. Spesso come presente nel test adam la carenza di testosterone si puo manifestare come calo della libido o voglia di far l amore. Nelle altre domande troviamo la presenza di stanchezza cronica persistente o una riduzione della forza fisica. Anche la riduzione dell altezza o la ''capacita' di godersi la vita'' e la sua correlazione con la depressione puo essere manifestazione dell ipogonadismo ( carenza di testosterone). La carenza di testosterone si puo manifestare anche con riduzione dell erezione e disfunzione erettile. L 'addormentarsi spesso e sentirsi senza energie , ma anche la stanchezza mentale puo essere correlata con la carenza di testosterone. Il test adam e' un test di screening per valutare la carenza di testosterone.In caso di carenza di testosterone e' necessario richiedere una visita medica , meglio se una visita andro-urologica. Infatti il medico deve rischiedere non solo il dosaggio del testosterone totale ma anche del testosterone libero e il dosaggio delle gonadotropine. Le gonadotropine ( fsh e lh) sono gli ormoni grazie ai quali una ghiandola che si trova nel cervello l ipofisi comanda tutte le altre ghiandole tra cui i testicoli. Questo e' necessario per differenziare un ipogonadismo primario che rappresenta una problematica proprio della ghiandola ipofisi da un ipogonadismo secondario in cui il problema e' dei testicoli che non hanno la capacita' di produrre testosterone. Il medico dovra dosare anche altri ormoni che possono determinare sintomi simili alla carenza di testosterone come ad esempio gli ormoni tiroidei o altri ormoni che con il loro aumento possono determinare una carenza secondaria di testosterone . Infatti nel pannello ormonale il medico dovra richiedere ormoni come ad esempio la prolattina basale e a 30 minuti , l estradiolo, il tsh , t3, t4 , il cortisolo ematico e il dheas e la vitd. La carenza di vitamina d frequente soprattutto di inverno puo determinare riduzione del testosterone. La carenza di testosterone oltre a poter determinare stanchezza cronica e disfunzione erettile puo determinare anche la riduzione della tolleranza allo zucchero con sviluppo del diabete o ad esempio l aumento del colesterolo ematico. La carenza di testosterone puo determinare negli uomini anche lo sviluppo di depressione, la riduzione della massa muscolare che facilita lo sviluppo del diabete e dell aumento di colesterolo ematico ma anche l aumento della massa grassa con lo sviluppo maggiore di infarto del miocardio. Anche le ossa sono interessate potendo sviluppare osteoporosi negli uomini cosi come avviene nelle donne in menopausa. Mai somministrare il testosterone senza uno studio ormonale di base perche in questo caso si potrebbe nascondere un tumore ad esempio ipofisario che al contrario e' necessario diagnosticare. Tra i farmaci che possiamo dare abbiamo i farmaci testosterone orali che oggi stanno scomparendo perche poco efficaci e con effetti collaterali. In genere utilizziamo i testosterone per via iniettiva perche piu efficaci e perche sono piu comodi da utilizzare essendo caratterizzati , in base al tipo, da una iniezione ogni 3 settimane o addirittura , alcuni , ogni 10 settimane. Il testosterone in gel non e' tanto consigliato perche sono scomodi da utilizzare essendo dei gel che devono essere cosparsi sulla cute e possono dare problemi di assorbimento irregolare. Altre tecniche per aumentare il testosterone si basano sugli integratori. Il tribulus terrestris e il fieno greco dati a dosi importanti possono aumentare il valore del testosterone ematico ( sia libero che totale ) con pochi effetti collaterali. Altri farmaci che possono essere utilizzati per la carenza di testosterone con carenza di libido puo essere curata con un altro estratto officinale :la yohimbina . Questo farmaco deve essere usata sotto consiglio andrologico in quanto puo avere effetti collaterali come nausea vomito e aumento della pressione. Una delle domande piu frequenti e' la correlazione dell utilizzo del testosterone e lo sviluppo di carcinoma prostatico. Questa e' una teoria del tutto sconfessata dato che l aumento dell eta' in cui aumenta la percentuale di carcinoma prostatico e' inversamente proporzionale ai livelli medi di testosterone . La somministrazione del testosterone al contrario riduce il rischio di infarto del miocardio negli ipogonadici #urologia #andrologia #disfunzioneerettile #testosterone #testosteronetherapy #testosteronelevel

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