Aging in male Andropause Testosterone Adrenopause DHEA Somatopause

Aging in male Andropause: Testosterone ↓ Adrenopause: DHEA ↓ Somatopause: GH/IGF-1 ↓

<조선일보 2008년 2월 10일> Clemens, a seven-time Cy Young Award winner with 354 career wins, has disputed the claims of his former trainer, Brian Mc. Namee, who told former senator George Mitchell he injected Clemens with steroids in 1998 and with steroids and human growth hormone in 2000 and 2001. Mitchell released his report on illegal performance-enhancing drugs in baseball last month.

노화와 성장호르몬 ② 성장호르몬 기능 ü 성장호르몬은 20대이후 매 10년 14. 4%씩 감소 ü h. GH 분비상태를 파악하기 위해선 분비가 안정적인 IGF-1을 측정하기도 함 IGF-1 (ng/m. L) Growth Hormone (mg/L) 400 14. 4%/10 yrs 60 th: 50% vs 20 th 70 th: 20% vs 20 th 350 300 250 200 150 100 50 0 10 70 20 30 40 50 60 하루동안 분비된 Growth Hormone (173명) Zadik Z, et al. J Clin Endocrinol Metab, 1985 0 30 40 50 60 70 > 70 한국인 정상 성인에서의 연령대별 IGF-1 (309명) 정윤석 등, 대한내분비학회지, 1992

노화와 성장호르몬 ⑤ 성장호르몬 효과 – 내장지방 ü 지방 분해 및 이동을 촉진하고, 지방조직 자체에서 유리지방산(Free Fat Acid)의 흡수를 억제 ü 내장지방 감소에 효과적임 18 y/o male Weight = 104 kg Height = 168 cm BMI = 36. 8 kg/m 2 6 Mo. Before After treatment VAT 134. 5 98. 7 VAT; visceral adipose tissue (cm 2) Before Treatment 26. 6% 감소 After Treatment Bengtsson B-A, Eden S, Lonn L. JCEM 1993, 76: 309 -317

성장호르몬 치료 받는 유명인 30/8/25 46/8/11 45/11/21 46/6/20 55/10/28

디클라제 임상 Review ü 심각한 이상반응은 없었으나 투여부위 발적등은 흔히 보임 Treatment Group 시험군 LB 03002 → LB 03002 (n=39) 대조군 Placebo → LB 03002 (n=38) n(%) Headache 3(7. 7%) 0(0. 0%) Generalized edema 2(5. 1%) 1(2. 6%) Arthralgia 1(2. 6%) 3(7. 9%) Face edema 1(2. 6%) Fatigue 1(2. 6%) Abdominal pain lower 1(2. 6%) 0(0. 0%) Abdominal distension 1(2. 6%) 0(0. 0%) Hyperhidrosis 1(2. 6%) 0(0. 0%) Diarrhea 0(0. 0%) 1(2. 6%) Iridocyclitis 0(0. 0%) 1(2. 6%) Muscle strain 0(0. 0%) 1(2. 6%) Edema peripheral 0(0. 0%) 1(2. 6%) Preferred term

Hypogonadism

Testosterone 2 -3% Free (unbound) (9 -30 ng/dl) 42% Weakly bound to albumin 55% Bound with high affinity to SHBG (biologically inactive) Bioavailable T (66 -417 ng/dl) Total T (240 - 1, 840 ng/dl)

Testosterone at different ages

남성호르몬 선별검사 대상 • Loss of libido or necessity of restoring libido • Failure of PDE-5 inhibitor • Diabetes Mellitus • Components of Metabolic syndrome

• O. R Nah M/56 Clinical – 결과: • Testosterone: 4. 2 ng/ml (420 ng/dl) • SHBG: 82. 1 nmole/L • Free Testosterone: 4. 45 ng/dl Case III

Dosage and Monitoring Recommendations Control: T Control: Hemoglobin PSA 0 6 WEEKS 18 Zitzmann M and Nieschlag E J Reproduktionsmed Endokrinol 3(2): 101 -116 (2006) Htc PSA 3

Recommended Treatment Regimen for TU (Nebido®)

Longterm Adaptation of Injection Intervals Control of T-levels before 30 -week (4 th )injection if Testosterone weeks 10 -15 nmol/L: <10 nmol/L: >15 nmol/L: Interval 12 weeks Interval 10 weeks Interval 14 Zitzmann M and Nieschlag E J Reproduktionsmed Endokrinol 3(2): 101 -116 (2006)

Hematocrit during Treatment with Nebido in 22 Hypogonadal Men for up to 8. 7 years 70 65 Hematocrit 60 55 50 sliding average 45 40 35 30 0 500 1000 1500 2000 days Zitzmann M et al. Endocrine Society Abstract Book: 535 (2006) 2500 3000 3500

PSA during Treatment with Nebido in 22 Hypogonadal Men for up to 8. 7 years 25 5 PSA µg/L 4 3 2 1 sliding average 0 0 500 1000 1500 2000 days Zitzmann M et al. Endocrine Society Abstract Book: 535 (2006) 2500 3000 3500

Prostate Volume during Treatment with Nebido in 22 Hypogonadal Men for up to 8. 7 years 25 35 Prostate volume m. L 30 25 sliding average 20 15 10 5 0 0 500 1000 1500 2000 days Zitzmann M et al. Endocrine Society Abstract Book: 535 (2006) 2500 3000 3500

Case 1 54세/남 ED, early det. PHx : 뇌하수체 종양 수술 2회 2004년 2월 IGF-1 29 ng/ml, DHEA-S 86 ug/dl testo 5. 6 • GH daily weekly • Lab상 변화(-) • •

Case 2 • • • 54세/남 ED, libido감소, 사정(-) 아랫배 나옴. 근육량 감소 IGF-1 149 Testo 5. 0 1 mon later IGF-1 208 경과 호전 후 fluctuation

Case 3 • 34세/남 • Gynecomastia, azoospermia • 호르몬 치료 계속 해 오던 분(andriol, 네비 도 • 2008년 4월 testo 0. 20 PSA 0. 227 Hb/Hct 13. 8/40. 1 네비도1차후 5월testo 2. 1 PSA 0. 868 Hb/Hct 14. 4/41. 6 네비도2차후 8월 testo 5. 3 PSA 1. 19 Hb/Hct 15. 1/44. 5

case 4 • 68세/남 • Ejaculation fail • Testo 2. 8 SHBG 24. 5 free. T 6. 46 PSA 1. 21 Hb/Hct 14. /39. 2 • 타클리닉 BPH로 tamsulosin복용중 • 네비도후 사정(+)