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Tratamiento con testosterona en el hipogonadismo de inicio tardÃo
Resumen
Introducción: El uso de la terapia de reemplazo con testosterona en hombres mayores se ha incrementado en los últimos años, lo que ha generado múltiples controversias aún no resueltas acerca de sus beneficios y riesgos potenciales, sobre todo los relacionados con el desarrollo o agravamiento de la enfermedad prostática o cardiovascular.
Métodos: Se realizó una revisión bibliográfica con el objetivo de ofrecer un estado de la cuestión que ayude a los médicos a tomar decisiones al considerar el tratamiento con testosterona en pacientes con hipogonadismo de inicio tardÃo. La búsqueda de información se realizó en las bases de datos Google Académico, Medline y Pubmed.
Conclusiones: El tratamiento con testosterona en el hipogonadismo de inicio tardÃo es seguro, racional y basado en evidencia, pero no se recomienda ofrecerlo a todos los hombres mayores con niveles bajos de testosterona sérica. Se aconseja en aquellos con sÃntomas manifiestos de deficiencia androgénica, sin cáncer de próstata activo, de mama o hÃgado, hematocrito elevado, hiperplasia prostática benigna con sÃntomas obstructivos graves, nódulo o induración prostática no evaluada, antÃgeno prostático especÃfico > 4 ng/mL (o > 3 ng/mL en pacientes con alto riesgo), apnea obstructiva del sueño severa no tratada, deseos de fertilidad a corto plazo, insuficiencia cardiaca no controlada, infarto agudo de miocardio o accidente cerebrovascular en los últimos SEIS meses o trombofilia. Se recomienda realizar monitoreo trimestral durante el primer año y luego según cada caso, que incluya evaluación de la respuesta clÃnica, de condiciones que pueden agravarse con el tratamiento y de parámetros de laboratorio.
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