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Der Altershypogonadismus des Mannes

Rationale Diagnostik und Therapie

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Zusammenfassung

Der Begriff Altershypogonadismus als Mischform aus primärem und sekundärem Hypogonadismus wird der Tatsache gerecht, dass im Alter sowohl die endokrine Kapazität der Testes als auch des hypothalamisch-hypophysären Systems eingeschränkt ist und es vermehrt zu Hypogonadismus kommen kann. Bisher kann nicht endgültig beantwortet werden, in welchem Ausmaß der Alterungsprozess mit dieser Erkrankung verknüpft ist und deren Symptome modifiziert. Die Testosterongabe für Männer mit Altershypogonadismus stellt ein Therapieprinzip dar, das nicht durch langfristige Studien abgesichert ist und sollte unter strengen Kontrollen in dafür spezialisierten Einrichtungen erfolgen. Derzeit werden Serumtestosteronspiegel <12 nmol/l mit Symptomen des Androgenmangels als Indikation für eine Testosteronsubstitution angesehen. Der Ausschluss eines Prostatakarzinoms stellt hierbei eine Vorbedingung dar. Die erektile Dysfunktion hat meist eine gefäßendothelbedingte Komponente und ist häufig nicht mit einem Altershypogonadismus assoziiert, sondern kann eher als Indiz für kardiovaskuläre Erkrankungen dienen. Eine Therapie mit Phosphodiesterase-5-Inhibitoren ist hier als Standard anzusehen und sollte nur im Falle eines gleichzeitigen Altershypogonadismus durch Testosterongaben ergänzt werden.

Abstract

The definition of late-onset-hypogonadism as a hybrid form of primary and secondary hypogonadism corresponds to pathophysiological facts of the age-related decline in gonadal as well as hypothalamic-pituitary functions, eventually manifesting in clinically relevant hypogonadism. To what extent advancing age modulates incidence and nature of hypogonadal symptoms has not been completely investigated. The benefits of testosterone substitution therapy in older men await demonstration in long-term studies and to date, it should be restricted to specialized centers. Currently, serum testosterone levels <12 nmol/l, accompanied by symptoms of androgen deficiency, are regarded as an indication for substitution, provided a prostate carcinoma has been excluded. While late-onset hypogonadism decreases libido, it does not play a direct role in the increasing incidence of erectile dysfunction with advancing age; this symptom is rather associated with vessel-endothelial impairment and may serve as a sentinel symptom for cardiovascular disease. Treatment with phosphodiesterase-5-inhibitors can be regarded as standard; in case of concomitant late-onset hypogonadism, testosterone will have a positive synergistic effect on erectile function.

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Authors and Affiliations

  1. Institut für Reproduktionsmedizin, Westfälische Wilhelms-Universität Münster

    M. Zitzmann &  E. Nieschlag

  2. Institut für Reproduktionsmedizin der Universität, Domagkstraße 11, 48149, Münster

    E. Nieschlag

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Zitzmann, M., Nieschlag, E. Der Altershypogonadismus des Mannes. Internist 44, 1313–1321 (2003). https://doi.org/10.1007/s00108-003-1044-z

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