Resume
Au cours du vieillissement, une altération de l'axe hypothalamo-hypophysotesticulaire a été identifiée. Une diminution très progressive de la testostérone plasmatique a été mise en évidence, indépendamment de phénomènes pathologiques. Elle est due à une altération testiculaire périphérique, comme le montrent la diminution de la réponse à l'hCG, l'augmentation de la LH, et la diminution du nombre de cellules de Leydig. L'augmentation progressive de la protéine de transport plasmatique des stéroïdes sexuels, la SHBG, explique une diminution encore plus nette de la testostérone biodisponible. Des études précises de la sécrétion gonadotrope montrent l'association à l'altération testiculaire d'une insuffisance gonadotrope relative partielle. Le testicule exocrine subit aussi une altération avec l'âge, avec augmentation de la concentration de FSH, diminution de l'inhibine, du nombre de cellules de Sertoli et de la production de spermatozoïdes. Si l'incidence des perturbations de la sexualité augmente avec le vieillissement, la corrélation entre niveau d'androgènes et sexualité n'apparaît que faible dans les études épidémiologiques, en raison du caractère multifactoriel de la sexualité humaine et de l'existence d'un seuil au-dessus duquel les androgènes n'augmentent plus l'activité sexuelle. La question des risques propres de l'androgénothérapie substitutive de l'hypogonadisme lié à l'âge reste posée. Si un effet positif sur un sensation générale de bien-être et sur la libido et l'absence d'effet néfaste sur les paramètres du métabolisme glucidique et lipidique ont été démontrés dans des études à court terme, le rôle exact des stéroïdes dans la genèse de l'hypertrophie bénigne de la prostate et dans la possible progression de microcarcinomes prostatiques reste méconnu. Des études complémentaires apparaissent nécessaires pour mieux préciser le rapport bénéfices/risques d'une androgénothérapie substitutive à long terme chez l'homme âgé.
Abstract
In men, aging is associated with progressive impairment of testicular function. Decrease in total testosterone levels with aging has been reported in many studies in normal healthy men. This decrease has a primarily testicular origin, as shown by decreased number of Leydig cells in histological studies, increased basal gonadotropin levels and decreased response to hCG. A greater decrease in bioavailable testosterone rather in than total testosterone concentrations is explained by the age-dependent increase in the SHBG concentration. Although immunoreactive gonadotropin levels are higher than in young men, a relative alteration of bioactive gonadotropin secretion by the pituitatry occurs in ederly men. Althought the definitive demonstration of an alteration of GnRH secretion by the hypothalamus cannot be established in healthy ederly men, such an alteration might be responsible for a decompensation of the testicular function in case of intercurrent illness. Increased FSH and decreased inhibin plasma levels are indicating a similar alteration in seminiferous tubules as directly demonstrated by histological data showing a decrease of Sertoli cell number and daily sperm production with aging. Although the incidence of sexual dysfunction increases with aging, the relationship between sexual behaviour and testicular endocrine function remained a mater of controversy. A threshold of testosterone action on sexual behavior might be responsible for the difficulty in establishing this relationship. Although some controled studies are available, the risk-to-benefit balance of androgen substitution in older male remained a controversial issue. A positive effect on sense of well-being and/or libido has been and the lack of adverse effect on lipid and carbohydrate metabolism had been demonstrated in short term studies, however, the role of androgens in the benign hypertrophy of the prostate and in stimulating the growth of latent prostate adenocarcinoma remained to be more clearly established by longterm controlled studies.
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Lejeune, H. L'andropause. Androl. 7, 66–75 (1997). https://doi.org/10.1007/BF03034520
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DOI: https://doi.org/10.1007/BF03034520