Izibonelelo ze-NIH Izifundo zokusebenzisa iHormone kwiimeko zezeMpilo eziguga
Njengoko amadoda ekhula, amanqanaba e-testosterone egazini lawo ahlala ehla. Oku kwehla kwe testosterone kuye kwaxilongwa ukuba kuholele kwizinto ezahlukahlukeneyo, ezifana nokusebenza kwezesondo, ukunciphisa i-anemia, kunye nekhefu.
I-Testosterone supplementation isetyenziswe ngamagqirha athile ukunceda ngemiba enjalo yomzimba. Kwiminyaka yakutshanje, kuye kwanda inzala ekwinkonzo yekliniki yokuxhaswa kwamatrosterone kumadoda amadala.
Nangona kunjalo, uphando olude, olude lwexesha elide alukwenziwanga ukuba lubone ukuba unyango lwe-testosterone lunceda ngeemeko ezinjalo.
Ngo-2003, iphaneli yeZiko lezeMpilo iphethe ukuba akukho ubungqina obaneleyo obuxhasa inkxaso ye-testosterone kumadoda amadala kwaye wakhuthaza uphando olongezelelweyo. Ngenxa yoko, ngo-2010, iNational Institute of Aging, eyinxalenye ye-NIH, yaqalisa i-Testosterone Trials (T iinzame) ukuba zibone ukuba i-testosterone ingancedisa iimpawu ezinxulumene namazinga aphantsi e-testosterone esecaleni ukuya kumdala (oko kukuthi, i-hypogonadism ).
Iimvavanyo ze-T ziza kusebenza njengengqungquthela yezilingo ezide kwaye zizinzileyo kwixesha elizayo. Iziphumo ezongezelelweyo ezivela kwiimvavanyo ze-T ziza kungena kwaye iziphumo ezipheleleyo zixutywe, kunye nokufakwa endaweni ye testosterone ehambelana nezinye izibonelelo kunye nemingcipheko ethile. Kufuneka kwenziwe uphando olungakumbi ukuba lubone ukulandelelanisa kwezi nzuzo kunye neengozi kunye nokusetyenziswa ngokuthe ngqo kwonyango lwe-testosterone.
Uvavanyo oluPhezulu
Iimvavanyo zeT ziyimvavanyo yee-klinikhi ezisixhenxe ezithathwe kwiindawo ezili-12 ezijikeleze ilizwe. Kulo lonke, amadoda angama-790 aneminyaka engama-65 okanye ngaphezulu anamaqondo aphantsi ka-testosterone kunye neempawu ezihambelana nazo. Okokuqala, abathathi-nxaxheba babefanelekile ukufumana olunye lwezilingo ezintathu eziphambili: Uvavanyo lweZenzo zoSondo, Uvavanyo lweZenzo zoMzimba, okanye uvavanyo lweValality.
Emva koko, abathathi-nxaxheba bangathatha inxaxheba kuyo nayiphi na enye iilingo apho bafanele khona.
Ngokukodwa, abathathi-nxaxheba bafuna ukukhalaza ngesifo sokungasebenzi, ukungasebenzi komzimba okanye ukunciphisa ubunzima bokuqala ukuba bafakwe kwiimvavanyo ze-T. Ngaphezulu, abathathi-nxaxheba babengabandakanywa ukuba babe neemeko ezithile, ezifana nomhlaza wesibeletho, iingxaki zeentliziyo, iingxaki zeengtso, njalonjalo.
Kuzo zonke izilingo, abathathi-nxaxheba babekwa ngokulandelelweyo kwiqela elithile lokulinga okanye le-placebo. Amadoda kwiqela lokulinga asebenzisa i-gel testosterone imihla ngemihla (AndroGel) iinyanga ezili-12; ngelixa iqela le-placebo lafumana i-placebo gel (ngaphandle kwe testosterone). Abathathi-nxaxheba bavavanywa rhoqo.
Kubaluleke kakhulu, izilingo zaphinda ziyimpumputhe, oku kuthetha ukuba abaphandi kunye nabathathi-nxaxheba abazange bazi ukuba yiyiphi igel.
Umsebenzi wezesondo, umsebenzi wePhysical, and Vitality Trials
Iziphumo ezivela kwiimvavanyo zokuqala ezintathu zabikwa ngoFebruwari 2016 kwiNew England Journal of Medicine .
Ukufakwa kwi-Trial Function Trial kufuneka abathathi-nxaxheba babe nokuhla kwe-libido kunye nomlingani wesondo ozimisele ukulala ngesibini ngenyanga.
Ukufakwa kwi-Function Triment Trial kufuneka abathathi-nxaxheba babe negalelo elincinci, ukuhamba nzima, nobunzima ukunyuka izitebhisi.
Amadoda awakwazi ukuhamba, ayenesifo esiyingozi, okanye abe ne-severe neuromuscular disease.
Ukufakwa kwi-Trial Utilities kufuna ukuba abathathi-nxaxheba babe nobukhulu obuphantsi kunye nokukhathala.
Ukuphakamisa amanqanaba e-testosterone ukusuka ephantsi ukuya kuluhlu oluqhelekileyo lomsebenzi wesondo ngokuthobeka (oko kukuthi, umsebenzi wesondo, umnqweno wesini, kunye nomsebenzi we-erectile) kunye nemeko kunye neempawu ezixinzeleleyo. Nangona kunjalo, i-testosterone supplementation ayizange iphucule ikhono lokuhamba okanye ubunzima.
Ngokubanzi, abaphandi bacetyisa ukuba ababengabandakanyeli abathathi-nxaxheba ukufumana izigqibo ezicacileyo kwezi zilingo ezintathu.
Uvavanyo lweHememia
NgoFebruwari 2017, iziphumo ezivela kwi-Trivia of Anemia Trial zapapashwa.
I-anemia yimeko apho kukho ukungabikho kwamaseli obomvu okanye i-hemoglobin egazini. Kwesithathu kwisithathu samadoda asebekhulile abane-anemia, oogqirha abanako ukuseka isizathu.
Ngomdlavuza, umzimba awufumani igazi elaneleyo le-oksijeni, elithwala i-hemoglobin elinezibomvu zegazi. I-anemia ingaba mnene okanye inzima. Abantu abane-anemia banokuziva bebuthathaka okanye bakhathele. Ezinye iimpawu ziquka ukungcola, ukuphefumula okufutshane, okanye iintloko.
I-anemia engapheliyo ingonakalisa intliziyo, ingqondo kunye nezinye izitho. Ngamanye amaxesha, i-anemia enkulu kakhulu ingabangela ukufa.
Uvavanyo lwe-Anemia lwalwenziwa ukuba lubone ukuba ngaba amadoda amadala anamaqondo angabonakaliyo anemia kunye neephantsi ze testosterone angafumana uphuculo kwizinga labo le-hemoglobin.
Iziphumo ezivela kwilingo lonyango libonise ukuba kukho ukwanda okwenyuka kwi-hemoglobin kumadoda amabini anesifo esilaphazelekayo kunye namadoda ane-anemia evela kwizizathu ezaziwayo abasebenzisa i-gel testosterone. Ezi ziphumo zingaba ngexabiso lekliniki, kwaye unyango lwe-testosterone lungasetyenziselwa ukukhulisa izinga le-hemoglobin kumadoda angaphezu kwama-65 anesifo esilaphazelekayo kunye ne-testosterone ephantsi. Nangona kunjalo, uphando oluninzi lufuneka luyenziwe.
Uvavanyo lweThambo
NgoFebruwari 2017, iziphumo ezivela kwi-Trial Trial zapapashwa.
Njengabantu abaneminyaka yobudala, abahlali nje benciphisa amanqanaba e-testosterone kodwa banciphisa ukuxinwa kwamathambo, i-bone volume, kunye ne-bone bone.
Uphando oluphambili malunga nemiphumo ye testosterone kwithambo ayilunganga. Ngomlingo weThambo, abaphandi bazama ukufumanisa ukuba ukunyameka kwamathambo kwandiswe emva kwonyango lwe-testosterone kumadoda amadala anamaqondo aphantsi e-testosterone.
Uxinzelelo lwe-Bone lwaluhlolwa ngokusetyenziswa kwamandla emibini x-radi absorptiometry (DEXA), kwaye amandla eethambo ahlolisiswa usebenzisa i-computed tomography (CT).
I-CT yindlela yokucinga esebenzisa i-x-ray ukuze ithathe imifanekiso engummiselo womzimba. I-DEXA ihlola ukusebenzisa i-dose-x-rays ephantsi ukuvavanya isisitye samaminerali kunye nokubala amanqaku. Ngamanye amazwi, i-DEXA ihlola ubungakanani bekhalsiyumu kunye nezinye izaminerals ezisethambo.
Ngaphandle kwe-vitamin D engaphezulu kwe-counter kunye ne-calcium supplements, amadoda athabatha imishanguzo echaphazela amathambo ayengabandakanywa kwisifundo. Ukongezelela, amadoda aphantsi kwe-DEXA amanqaku ayengabandakanywa kwisifundo.
Abaphandi bafumanisa ukuba abantu abafumana unyango lwe-hormone bafumana ukwanda kwamandla ethambo. Amandla akhula aphezulu kakhulu emgodleni kunokuba ayengumlenze. Nangona kunjalo, njengamanye amalinge o-T, uphando olongezelelweyo lufanele lwenziwa. Kufuneka kwenziwe uphando oluninzi kwiminyaka emininzi ukuze kuqinisekiswe ukuba i-testosterone inganciphisa ingozi yokuphulwa kwethambo.
Uvavanyo lweSebenzi loCognitive
NgoFebruwari 2017, iziphumo ezivela kwi-Trigmitive Function Trial zapapashwa.
Ngokwe-Resick and other authors of the study:
Ukuguga kunxulumene nokuhla kweminye imisebenzi engqondweni, kuquka imemori yomlomo kunye nomboniso, umsebenzi olawulayo, kunye nekhono lomhlaba. Ukuguga kumadoda kudibaniswa nokunciphisa i-serum testosterone, ukuphakamisa ukuba ukunciphisa ukujikeleza kwee-testosterone kunokuncedisa ukuhla kweengxaki ezinxulumene neminyaka.
Kule sifundo, amadoda amadala aphantsi kwe testosterone kunye nokukhubazeka kweememori ezidala ubudala banikwa i-testosterone. Ukukhubazeka kweememori ezinxulumene nobudala bechazwe yimimangalo yememori kunye nokusebenza kakubi kwiimvavanyo zememori yomlomo kunye nebonwayo.
Olu phofu aluzange lubonise ukuba unyango lwe-testosterone luncedise ukukhubazeka kwamemori okudala.
Uvavanyo lweeNdio
Izifundo malunga nemiphumo ye-testosterone kwimiphumo ye-cardiovascular ziphikisana. I-Cardiovascular Trial yenzelwe ukunqunyulwa ukuba i-testosterone yokuxhaswa kumadoda amadala anamaqondo aphantsi e-testosterone anganciphisa ukuphuhliswa kwevolumu ye-coronary artery.
Umqulu wepalatiary yamaconary noncalcified unxulumene nokuhlaselwa kwintliziyo kunye neengxaki zentliziyo elandelayo. Uvavanywa usebenzisa i-coronary computed tomographic angiography, uvavanyo olukhethekileyo lokuhlola.
Abaphandi bafumanisa ukuba kumadoda athatha i-testosterone gel, kwakukho ukwanda okwenyuka kumqulu weconta we-coronary noncalcified. Oku kufunyaniswa kukubhekiselele ngenxa yokuba ukwanda kwendwangu yeplants kunciphisa ukuhamba kwegazi lomgudu, ongayonakalisa. Iingqungquthela zeCononary zinika intliziyo ngegazi.
Kwakhona, njengakanye nezinye izilingo ze-T, uphando olongezelelweyo lufuneka luyenze ukuze lubone impembelelo yangempela yale sifundo.
Okukwintsusa
Iziphumo zezi zifundo zibonisa ukuba unyango lwe-testosterone kumadoda amadala aphantsi kwe-testosterone angabangela ezinye iinzuzo. Nangona kunjalo, unyango lwe-testosterone lungaphinda lube nobungozi. I-trade-off ngqo ayiyazi. Izifundo ezikhulu kunye nezide zifuneka zenziwe ukuze kucaciswe imiphumo ye testosterone entliziyweni yempilo, impilo yeethambo, ukukhubazeka kunye nokunye.
Ukuba uyindoda endala ene testosterone ephantsi kwaye unomdla wokuthatha i-testosterone, esi sigqibo kufuneka sicingwe ngenyameko kunye nodokotela wakho. Ugqirha wakho uya kukwazi ukuphonononga kangcono umlinganiselo weemeko zakho nokuba ingaba i-hormone substitution ingakubeka engozini. Kuyinto engalunganga ukuba umntu angene kwi-supplementation ye-hormone ngaphandle kolawulo lwegqirha. Kungenxa yokuba i-hormone eyenzeka ngokwemvelo emzimbeni ayithethi ukuba inokuthathwa ngaphandle kwemiphumo emibi.
Ekugqibeleni kunye nemilinganiselo emihle, cinga ngolu hlobo lathiso malunga novavanyo lwe-T oluvela kwi-NIH:
Ngenxa yokuba iinzame ze-T zaqhutyelwa kumadoda amadala angenayo imbangela ye-testosterone ephantsi ngaphandle kokuguga, ezi ziphumo azisebenzi kumadoda anamazinga angama-hormone aphantsi ngenxa yezizathu ngaphandle kokuguga. Naliphi na umntu oqwalasela unyango lwe-hormone kufuneka axoxe ngezibizo kunye neenzuzo kunye nomboneleli wezempilo.
> Imithombo:
> Budoff, MJ, et al. I-Testosterone Treatment kunye neCononary Artery Plaque Volume ku-Older Men With Testosterone ephantsi. JAMA. 2017; 317 (7): 708-716.
> Ukuhlaziya, SM, kunye no-al. Ukwelashwa kweTesttosterone kunye neMisebenzi yokuCocnitive kwi-Older Men With Testosterone ephantsi kunye neNkcukacha eziNxulumene neNkumbulo. JAMA. 2017; 317 (7): 717-727.
> Roy, CN, et al. Umbutho weeNqanaba zeTesttosterone kunye ne-Anemia kubantu abadala. JAMA lwangaphakathi lweMithi. NgoFebruwari 21, 2017 (e-pub).
> Snyder, PJ, et al. Impembelelo yoTyango lweTesttosterone kwi-Volumetric Bone Bone and Strength in Men Older With Testosterone ephantsi Uvavanyo lweCliniki olulawulwayo. JAMA lwangaphakathi lweMithi. NgoFebruwari 21, 2017 (e-pub).
> Snyder, PJ, et al. Iimpembelelo zoTyango lweTesttosterone kuMadoda amadala. I-New England Journal of Medicine. 374 (7): 611-624.