טסטוסטרון ומחלות לב וכלי דם

שלום אני בן 40, סובל מטסטוסטרון נמוך 5.80 (ערכי הנורמה- 5.80 - 28.00) בבירור שעברתי לפני מספר שנים לא נמצאה הסיבה לכך (אם כי כעת זה הגיע לרמה הנמוכה ביותר שהיה לי) קראתי שיש קשר בין רמות נמוכות של טסטוסטרון להתפתחות מחלות לב וכלי דם ועוד. אלו בעיות מלבד התפקוד המיני יש בטסטוסטרון נמוך? ועד כמה זה משמעותי לעניין הלב? האם יש המלצה לטפל בטוסטסטרון נמוך בגלל הבעיות האחרות מלבד הליבידו? תודה

אני מצאתי לנכון לצרף לך חוות דעת של אחד המומחים במובילים בתחום, פרסם לאחורנה. Low testosterone is an inevitable consequence of aging, but it results in significant symptoms for many men. While pituitary failure and testicular failure are causes of low testosterone levels, aging is the most common cause of low testosterone in US men. The evidence for the effectiveness and safety of testosterone replacement therapy (TRT) remains controversial. Recent studies have shown both risk and benefit associated with TRT in the aging male in frequency of cardiac events and complications. Data from a large VA study by Shores and colleagues indicated an advantage in all-cause mortality in men with higher testosterone levels and improved survival of men receiving TRT.1,2 However, more recent population-based studies have shown increased cardiac adverse events in men receiving TRT.3,4 This concern is mitigated by other population studies that have shown a decreased risk for cardiac events in hypogonadal men taking TRT.5 As a result of an FDA advisory committee in September 2014, the US FDA has recently published additional information and changes in TRT guidance. They have directed providers of TRT to discuss the cardiovascular risks in package inserts, mandated further studies and data surrounding long-term risks of TRT; and have redefined the hypogonadal male patient. The FDA has also amended the definition of men requiring TRT to the following: “Testosterone is FDA-approved as replacement therapy only for men who have low testosterone levels due to disorders of the testicles, pituitary gland, or brain that cause a condition called hypogonadism. Examples of these disorders include failure of the testicles to produce testosterone because of genetic problems, or damage from chemotherapy or infection. However, FDA has become aware that testosterone is being used extensively in attempts to relieve symptoms in men who have low testosterone for no apparent reason other than aging. The benefits and safety of this use have not been established.”6 While manufacturers and providers must take these warnings seriously, many men with significantly low testosterone levels benefit greatly from TRT. A discussion of cardiovascular risks and careful follow-up of men on TRT is critical for patient safety. בברכה, דר דדשב