Andropausa: a che età inizia
Table of Contents
Andropausa
L’invecchiamentoriguarda tutti i sistemi e apparati dell’organismo, compresa la sfera endocrina. Tra gli ormoni anche quelli sessuali vanno incontro a una graduale riduzione dei livelli circolanti. Tale realtà biochimica, cui segue una corrispondenza clinica, sotto forma di una sintomatologia specifica, identifica una sindrome che in passato è stata etichettata con il termine di“andropausa”. In realtà, nell’epoca più recente tale terminologia è stata modificata perché contiene l’errore fondamentale di assimilazione con lamenopausa,evento di interruzione dell’attività gonadica femminile. La realtàosservabile nel maschio è ben diversain quanto:
- ilcalo androgenico maschileresta per definizione una possibilità, che si può osservare in una crescente percentuale di soggetti con l’avanzare degli anni, associata ad una percentuale di soggetti con valori di testosterone all’interno del limite di normalità. A partire dai 40 anni i testicoli cominciano infatti a produrre sempre meno testosterone, con un calo di circa l’1 per cento ogni anno: intorno ai 50 anni, e ancor di più a 60 anni e oltre, la quantità in circolo dell’ormone può essere talvolta talmente bassa da provocare i sintomi di un vero e proprio climaterio in versione maschile. Le concentrazioni attese ad una certa età sono quindi in larga parte dipendenti dalle concentrazioni di partenza a 40 anni. Questi iniziali livelli di testosterone sono 400 ng/dl nel 30% degli uomini, per cui sarà questa la percentuale di uomini che a 60 anni avranno testosterone inferiore a 230 ng/dl e, con ciò, sintomi e segni certi di ipogonadismo).
- Diversa è la situazione inerente lafertilità.A tale proposito è stato dimostrato che laspermatogenesicontinua anche in età avanzata e che, accanto a quadri conoligozoospermia/ azoospermia, è possibile trovare maschi molto anziani con concentrazioninemaspermiche nella norma; in tal senso numerosi studi hanno evidenziato che gli unici parametri che subiscono una significativa modificazionesono il volume dell’eiaculatoe lamotilità nemaspermica.
Proprio per cercare di eliminare l’associazione andropausa/menopausa, considerando la prima il corrispettivo maschile della seconda, il termine andropausa è stato sostituito con altri che ricalcavano letteralmente il nucleo centrale del problema (calo androgeno):
- ADAM(PADAM)partial androgen Deficientis in Agin Maleè, più recentemente di LOH (Late Onset hypogonadism). Tale definizione dice che la progressiva riduzione delle concentrazioni degli ormoni sessuali maschili è dovuta a un ipogonadismo ad insorgenza tardiva.
Ipogonadismo ad insorgenza tardiva
L’ipogonadismo ad insorgenza tardiva (LOH o Andropausa) negli uomini in invecchiamento è una sindrome clinica e biochimica causata da un calo del testosterone che avviene simultaneamente al sopravanzare dell’età.
Sintomi
- aumento della massa adiposacon localizzazione viscerale;
- riduzione dei peli corporeie alterazioni cutanee;
- disturbi del sonno;
- riduzione della densità minerale osseacon quadri variabili che vanno dall’ osteopenia all’osteoporosi con significativo aumento del rischio di fratture;
- modificazione del tono dell’umoree/o delle funzioni cognitive con possibile irritabilità, affaticabilità e depressione
- riduzione del desiderio sessualecon peggioramento della funzione erettile. Inoltre, il testosterone induce nei vasi un rilasciamento muscolare sia endotelio-indipendente, dovuto verosimilmente alla sua azione sui canali del potassio, sia endotelio-dipendente, con l’attivazione dell’ossido nitrico sinteasi (NOS) e una maggiore espressività e attività della fosfodiesterasi di tipo 5 (PDES). Questa azione consente di comprendere l’effetto del testosterone sull’erezione e il motivo per cui una bassa testosteronemia può attenuare la risposta terapeutica agli inibitori della PDES.
Terapia
Per combattere gli effetti dell’andropausa e del calo del testosterone, si procede di solito con una terapia coadiuvante di ormone maschile, in modo tale da apportare benefici diretti negli apparati che lo necessitano, senza però dimenticare di tenere sotto controllo gli effetti collaterali che un approccio ormonale può apportare all’organismo. In pratica si introduce nell’organismo una certa quantità di testosterone così da raggiungere le concentrazioni normali. Prima di affrontare la terapia, è necessario valutare le condizioni generali di salute e soprattutto l’eventuale personale predisposizione a sviluppare untumore della prostata. Per tale motivo è necessario eseguire durante il trattamento, controlli periodici e l’ecografia transrettale, per controllare lo stato della prostata. La somministrazione può essere effettuata in modo diversi, attraverso l’uso dicompresse, iniezioni o cerottimentre i dosaggi e i tempi di somministrazione vengono decisi dall’andrologo caso per caso.
TI POTREBBERO INTERESSARE:
Menopausa: il ritorno al piacere
Menopausa: disturbi e alimenti per restare in linea
Affrontare serenamente la menopausa
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