Izinzuzo ze-NIH zokusebenzisa iHhommone yezimo zezempilo eziguga
Njengoba amadoda ekhulile, amazinga e-testosterone egazini lawo avame ukuwa. Lokhu kwehla ku-testosterone kuye kwaxoshwa ukuholela ezintweni ezihlukahlukene, njengokunciphisa umsebenzi wezocansi, i-anemia, kanye nekhefu lamathambo.
I-testosterone supplementation isetshenziswa abanye odokotela ukusiza ngezinkinga ezinjalo zomzimba. Eminyakeni yamuva, kuye kwanda isithakazelo ekusizeni komtholampilo we-testosterone supplementation kumadoda amadala.
Kodwa-ke, izifundo ezinkulu, zesikhathi eside azizange zenziwe ukuze zibone ukuthi ukwelashwa kwe-testosterone ngempela kusiza yini ngalezi zimo.
Ngo-2003, i-Institute of Medicine panel yaphetha ngokuthi kwakungekho ubufakazi obanele obusekela izinzuzo ze-testosterone kumadoda amadala futhi kunconywa olunye ucwaningo. Ngenxa yalokho, ngo-2010, i-National Institute of Aging, engxenyeni ye-NIH, yasungula i-Testosterone Trials (T Trials) ukuthola ukuthi ngabe i-testosterone ingasiza yini ngezimpawu ezihambisana namazinga aphansi e-testosterone esesizukulwaneni esidala (okungukuthi, i-hypogonadism ephawulekayo ).
Izivivinyo T zizoba yisiqalo sokuhlolwa okulindelekile futhi okunamandla esikhathini esizayo. Imiphumela eminingi evela ku-T Trials manje isingene futhi imiphumela yonke ihlanganisiwe, futhi ukufaka esikhundleni se-testosterone kufakwe ezinye izinzuzo nezinye izingozi. Ucwaningo olungaphezulu luyadingeka ukuze lubone ukulingana kwalezi zinzuzo kanye nezingozi ezingase zibe khona kanye nesevisi eqondile yomtholampilo we-testosterone.
Ukuhlola okujwayelekile T
Izivivinyo T ziyisilingo sezilingo eziyisikhombisa zemitholampilo ezithathwe ezindaweni ezingu-12 ezungeze izwe. Kuzozonke, amadoda angu-790 aneminyaka engu-65 noma ngaphezulu anamazinga aphansi we-testosterone nezibonakaliso ezihambisana nawo. Okokuqala, ababambiqhaza kufanele bafanelekele olunye lwezivivinyo ezintathu eziyinhloko: Ukuhlolwa Kwemisebenzi Yobulili, Ukuhlolwa Kwemisebenzi Yomzimba, noma Ukuhlolwa Kwemvelo.
Khona-ke, ababambiqhaza bangabamba iqhaza kunoma yiziphi ezinye izilingo abazifanelekayo.
Ngokuqondile, ababambiqhaza badinga ukukhononda ngokungahambi kahle ngokobulili, ukungasebenzi ngokomzimba, noma amandla okunciphisa ukuze kuqale afakwe ezilingweni ze-T. Ngaphezu kwalokho, ababambiqhaza babenqatshelwe ukuthi babe nezimo ezithile, njengomdlavuza we-prostate, izinkinga zenhliziyo, izinkinga zezinso, njalonjalo.
Kuzo zonke izilingo, ababambiqhaza babekwa ngezikhathi ezithile kuqembu lokuhlola noma le-placebo. Amadoda eqenjini lokuhlola asebenzisa i-gel testosterone nsuku zonke (AndroGel) izinyanga ezingu-12; kanti, iqembu le-placebo lathola i-placebo gel (ngaphandle kwe-testosterone). Abahlanganyeli babevame ukuhlolwa.
Okubaluleke kakhulu, lezi zivivinyo zaphuphuthekiswa kabili, okusho ukuthi abacwaningi nabahlanganyeli babengazi ukuthi yikuphi igel.
Umsebenzi wezocansi, umsebenzi womzimba, kanye nokulingwa kobunzima
Imiphumela evela ezivivinyweni zokuqala ezintathu yabika ngoFebhuwari 2016 eNew England Journal of Medicine .
Ukufakwa ku-Trial Function Trial Abahlanganyeli abadingekayo ukuba banciphise i-libido kanye nomlingani ocansini ozimisele ukulala naye izikhathi ezimbili ngenyanga.
Ukufakwa kwi-Physical Function Trial abahlanganyeli abadingekile ukuba babe nejubane elincane elincane, ukuhamba nobunzima nokuhamba nobunzima ukugibela izitebhisi.
Amadoda ayengakwazi ukuhamba, abe ne-arthritis enamandla, noma abe nezifo ezimbi kakhulu ze-neuromuscular.
Ukufakwa kwi-Vitality Trial kudingekile ukuthi abahlanganyeli babe nokuqina okuphansi nokukhathala.
Ukukhulisa amazinga we-testosterone ukusuka phansi kuya kuhla olujwayelekile ukwenza umsebenzi wobulili ngokuzithoba (okusho, umsebenzi wobulili, isifiso socansi, nesenzo se-erectile) kanye nemimoya nezimpawu zokucindezeleka. Noma kunjalo, ukwesekwa kwe-testosterone akuzange kuthuthukise ikhono lokuhamba noma ubungqabavu.
Ngokubanzi, abacwaningi basikisela ukuthi kwakungekho abahlanganyeli abanele ukudweba iziphetho ezicacile kulezi zivivinyo ezintathu.
Isivivinyo se-Anemia
Ngo-February 2017, imiphumela evela kuHlelo Lokudalwa Kwegazi Eliyanyatheliswa.
I-anemia yisimo lapho kunesifo samaseli abomvu noma i-hemoglobin egazini. Ku-third-third amadoda asebekhulile abane-anemia, odokotela abakwazi ukusungula imbangela.
Nge-anemia, umzimba awutholi igazi elanele-oksijini-okhebile, elithwala i-hemoglobin elisevikini elibomvu legazi. I-anemia ingaba mnene noma ibe nzima. Abantu abane-anemia bangazizwa bebuthakathaka noma bekhathele. Ezinye izimpawu zihlanganisa ukuzondeka, ukuphefumula, noma ikhanda.
I-anemia ehlala njalo ingalimaza inhliziyo, ubuchopho, nezinye izitho. Ngezinye izikhathi, i-anemia enamandla kakhulu ingabangela ukufa.
Isivivinyo se-Anemia senziwa ukuze sibone ukuthi ngabe amadoda amadala anamazinga angeke achazwe futhi aphansi e-testosterone angathola ngcono emazingeni abo e-hemoglobin.
Imiphumela evela kusivivinyo somtholampilo yabonisa ukuthi kunokwanda okuphawulekayo kwe-hemoglobin kula madoda amabili anemia engahlongozwayo kanye namadoda ane-anemia ezibangelwa izimbangela ezaziwayo abasebenzisa i-gel testosterone. Le miphumela ingaba yinani lemitholampilo, futhi ukwelashwa kwe-testosterone kungasetshenziselwa ukukhulisa amazinga we-hemoglobin emadodeni angaphezu kuka-65 anesifo se-anemia esingahlongozwayo nesiphansi se-testosterone. Kodwa-ke, ucwaningo olungaphezulu luyadingeka lwenziwa.
Bone Trial
Ngo-February 2017, imiphumela evela ku-Bone Trial yashicilelwa.
Njengoba abantu bekhula, abakwazi ukuhlaselwa kuphela emazingeni e-testosterone kodwa futhi banciphisa emithini yamaminerali, amathambo amathambo, namandla amathambo kanye nokwanda kwamathambo.
Ucwaningo oluphambili olumayelana nemiphumela ye-testosterone emathanjeni aluhambisani. Nge-Trial Bone, abacwaningi bazama ukuthola ukuthi ubukhulu bamathambo banda kanjani emva kokwelashwa kwe-testosterone kumadoda amadala anamazinga aphansi e-testosterone.
Ukuxilongwa kwamathambo kwahlolwa ngokusetshenziswa kwamandla amabili we-ray-ray absorptometry (DEXA), futhi amandla amathanga ahlolwe ngokusebenzisa ukuhlolwa kwe-computed tomography (CT).
I-CT yindlela yokucabanga esebenzisa ama-x-ray ukuze athathe izithombe ezithintekayo zomzimba. I-DEXA yokuhlola isebenzisa i-dose-x-rays ephansi ukuhlola ubuciko bamathambo esitokisini nokubala izikolo. Ngamanye amazwi, i-DEXA ihlola ukuthi mangakanani i-calcium namanye amaminerali asetsheni.
Ngaphandle kwamavithamini D ngaphezu kwe-counter ne-calcium, amadoda athatha imishanguzo ethinta amathambo ayengabandakanyi esifundweni. Ukwengeza, amadoda anamazinga aphansi we-DEXA ayengeniswa ekutadisheni.
Abacwaningi bathola ukuthi amadoda athola ukwelashwa kwe-hormone athola ukwanda kwamandla ethambo. Amandla ayanda kakhulu emgogodleni kunokuba ayesenyakatho. Kodwa-ke, njengamanye amaT Trials, ucwaningo olwengeziwe luzodingeka lwenziwe. Ukutadisha okukhudlwana eminyakeni eminingi kuzodingeka kwenziwe ukuze kunqume ukuthi ngabe i-testosterone inganciphisa yini ingozi yokuphuka kwamathambo.
Isivivinyo somsebenzi wokuqonda
Ngo-February 2017, imiphumela evela kuCognitive Function Trial yashicilelwe.
Ngokusho ukugodla nabanye abalobi besifundo:
Ukuguga kuhlotshaniswa nokuncipha kwemisebenzi ethile engqondweni, kuhlanganise imemori yokukhuluma nokubonwayo, umsebenzi wokuphatha, kanye nekhono lokuhlala. Ukuguga kwamadoda kuhlobene nokuncipha kwe-testosterone ye-serum, okukhulisa ukuthi kungenzeka ukunciphisa ukuxilongwa kwe-testosterone kungaholela ekunciphiseni okuphathelene nokukhula komqondo.
Kulesi sifundo, amadoda amadala ane-testosterone ephansi kanye nokukhubazeka kwememori ehambisana neminyaka anikwe i-testosterone. Ukukhubazeka kwememori okuhlotshaniswa nobudala bechazwe izikhalazo zememori nokusebenza okungasebenzi kahle ekuvivinyweni kwememori yomlomo nokubukwa.
Lesi sifundo asizange sibonise ukuthi ukwelashwa kwe-testosterone kwasiza ngokukhubazeka kokukhumbula imemori.
Isivivinyo senhliziyo
Izifundo eziphathelene nemiphumela ye-testosterone emiphumeleni yezinhliziyo ziphikisana. I-Trial Cardiovascular Circle yenzelwe ukunquma ukuthi ukufaka isisindo se-testosterone kumadoda amadala anamazinga aphansi we-testosterone anganciphisa ukuthuthukiswa kwevolumu ye-artery yamakhemikhali engekho emthethweni.
Ivolumu yamapayipi ye-aron corcinary noncalcified ixhunywe ukuhlaselwa kwenhliziyo nezinkinga zenhliziyo ezilandelayo. Ihlolwe ngokusebenzisa i-coronary computed tomographic angiography, ukuhlola okukhethekile okuxilongwa.
Abacwaningi bathola ukuthi emadodeni athatha i-testosterone gel, kwaba khona ukwanda okuphawulekayo kwevolumu ye-artery coronary engekho emthethweni. Lokhu kutholakala mayelana nokuthi ukwanda kwevolumu ye-plaque kunciphisa ukugeleza kwegazi kwe-coronary, okungaba yingozi. I-coronary arteries yenza inhliziyo ngegazi.
Futhi, njengamanye amaT Trials, ucwaningo olwengeziwe luzodingeka lwenziwe ukuze lubone impendulo yangempela yalolu cwaningo.
Ngaphansi
Imiphumela yalezi zifundo ibonisa ukuthi ukwelashwa kwe-testosterone kumadala amadala ane-testosterone ephansi angenza ezinye izinzuzo. Noma kunjalo, ukwelashwa kwe-testosterone kungase kuhlanganise nezingozi. I-trade-off ngqo ayiziwa. Izifundo ezinkulu nezide kudingeka zenziwe ukuze kucaciswe imiphumela ye-testosterone enenhliziyo yezempilo, impilo ye-bone, ukukhubazeka, nokuningi.
Uma uneminyaka endala ene testosterone ephansi futhi unesithakazelo ekuthatheni u-testosterone, lesi sinqumo kufanele sicatshangelwe ngokucophelela nodokotela wakho. Udokotela wakho uzokwazi ukuhlola kangcono ukulinganisela kwezimo zakho nokuthi ngabe i-hormone esikhundleni sakho ingakubeka engozini engase ibe yingozi. Kungumqondo omubi wokuthi noma ubani angene ekufakweni kwe-hormone ngaphandle kokuqondiswa udokotela. Kungenxa yokuthi ama-hormone akhona ngokwemvelo emzimbeni asisho ukuthi angathathwa ngaphandle kwemiphumela emibi.
Ekugcineni futhi ngesilinganiso esihle, cabanga ngalesi siqondiso sokuhlukanisa mayelana nezivivinywa T ezivela ku-NIH:
Ngenxa yokuthi izivivinywa T zaqhutshwa kumadoda amadala angenaso isizathu esizwakalayo se-testosterone ngaphandle kokuguga, le miphumela ayisebenzi kumadoda anezinga eliphansi le-hormone ngenxa yezizathu ngaphandle kokuguga. Noma yimuphi umuntu ocubungula ukwelashwa kwe-hormone kufanele akhulume ngezimo ezilimazayo kanye nezinzuzo nomhlinzeki wezempilo.
> Imithombo:
> Budoff, MJ, et al. I-Testosterone Ukwelashwa ne-Coronary Artery Volume Volume ku-Older Men With Testosterone Ephansi. I-JAMA. 2017; 317 (7): 708-716.
> Ukubuyisela kabusha, SM, et al. I-Testosterone Ukwelashwa Nokusebenza Kokuqonda Kwamadoda Akhulile Ngama-Testosterone Ephansi kanye Nezimo Zokukhumbula Iminyaka Ehlanganisiwe. I-JAMA. 2017; 317 (7): 717-727.
> Roy, CN, et al. I-Association of Levels Testosterone Ne-Anemia Emadodeni amadala I-Trial Controlled Clinical Trial. I-JAMA Imithi Yangaphakathi. Ngo-February 21, 2017 (e-pub).
> Snyder, PJ, et al. Umphumela we-Testosterone Treatment ku-Volumetric Bone Massitude kanye Namandla Kwabesilisa Abadala Nge-Testosterone Ephansi I-Trial Clinic Trial Trial. I-JAMA Imithi Yangaphakathi. Ngo-February 21, 2017 (e-pub).
> Snyder, PJ, et al. Imiphumela ye-Testosterone Ukwelashwa Kwabesilisa Abadala. I-New England Journal of Medicine. 374 (7): 611-624.