I would like to dispel the concept that endocrinopathy in older men is limited to testosterone alone. Although hypotestosteronemia is the most frequently detected hormonal pathology associated with the aging process (see age-related androgen deficiency ), the production of other hormones is also deeply affected by age-related changes. These hormones should also be given increased attention, since changes in their concentrations may be responsible for certain manifestations previously associated exclusively with testosterone deficiency.
DHEA and DHEA-S
DHEA and DHEA-C are "weak" androgens, produced mostly in the adrenal glands. A decrease in the level of DHEA, as well as its sulphate DHEA-S, is more likely a more characteristic sign of the elderly than hypogonadism. By the age of 50, men experience a decrease in the level of DHEA by 30% compared with the level of the hormone before the age of 30. There is a widespread belief that a decrease in the level of DHEA affects a decrease in the sense of well-being and that exogenous replacement of the hormone leads to an improvement in the quality of life parameters. However, the study did not reveal any positive effect of DHEA replacement therapy compared with placebo.
A growth hormone
The production of growth hormone on puberty also decreases with age, by about 14% per decade. Since the production of circulating insulin-like growth factor-1 (IGF-1) is controlled by the level of growth hormone, their decrease occurs simultaneously. These changes are associated with a decrease in muscle mass, bone density, hair thinning and manifestations of obesity - the symptoms described in hyponadal conditions. The prescription of growth hormone is able to reverse these changes and is more effective in eugonadal (with a testosterone level of more than 12 nmol / l) men than in their peers with hypogonadism. The question of whether a possible clinical improvement after the prescription of growth hormone can outweigh the unwanted side effects and justify the financial costs requires further research.
Melatonin excretion by the pineal gland in response to hypoglycemia and darkness also decreases with age, regardless of these stimuli. The physiological role of the pineal gland is not fully understood, but it is known that it is involved in the gonadal function and regulation of biorhythms. It is believed that the administration of melatonin can have a significant effect on sleep disorders, often seen in the elderly. As noted earlier, severe hypogonadism is associated with impaired melatonin production; thus, the association of some symptoms (sleep disorder) exclusively with a deficiency of one or another hormone is questionable. A wide range of direct and indirect effects of melatonin on many systems of the human body was revealed.
With age, there is an increase in serum thyroid-stimulating hormone (TSH) and a decrease in thyroxin, although the level of TSH in elderly people suffering from hypothyroidism is lower than in young patients with the same disease. Hypothyroidism should be suspected if there are unexplained high cholesterol and creatine phosphokinase levels, severe constipation, congestive heart failure with cardiomyopathy, or macrocytic anemia. In older people, there may be overt or subclinical hypothyroidism. The diagnosis may not be clinically obvious, and only the biochemical accompaniment of clinical suspicions can confirm the diagnosis. Symptoms of hypothyroidism can mask the symptoms of hypogonadism.
The production of corticosteroids (cortisol, cortisone, aldosterone) and estradiol in men does not change throughout life. On the contrary, the production of leptin produced by adipocytes is disturbed by the state of hypogonadism, which provokes changes in the redistribution of adipose tissue in men with insufficient testosterone levels. Leptin levels can be reduced by administering androgen replacement therapy , which usually leads to a decrease in obesity.
Determination of levels of DHEA, DHEA-C, melatonin, growth hormone and IGF-1 are not shown in the assessment of uncomplicated age-related androgen deficiency. In special cases or for extensive clinical research, determining the concentration of these and other hormones may be justified.
Dedov I. I., Kalinchenko S. Yu. “Age-related androgen deficiency in men”.