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Fertility and sexual life of men after their forties and in older age

机译:四十多岁和年龄较大的男性的生育能力和性生活

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Owing to the demographic development, the aging male will require more consideration in future. In contrast to a rapid decline of estradiol during menopause in women, the process of aging in the male is retarded and subject to high individual variations. Impairment of spermatogenesis is observed as a continuous process occurring over decades. However, only about 50% of men in their eighties show complete loss of fertility. In principle, spermatogenesis may be retained well into senescence. Of importance for the individual health condition is the fact that the number of Leydig cells declines with advancing age. Thus, altered sex hormone concentrations in aging men result from both functional disturbances and a gradual reduction in Leydig cells. Furthermore, an impaired feed-back mechanism of the pituitary-gonadal axis occurs, with disappearance of the circadian testosterone (T) rhythm. LH and FSH levels are increased, and a reduced bioavailability of sex hormones is observed. Lower total testosterone concentrations in men over 60 years are accompanied by clinical signs of reduced virility, such as decreased muscle mass and strength as well as reduced sexual hair growth and libido. An age-related decline in androgen secretion and plasma testosterone levels therefore suggests the use of androgen supplementation. However, there is a lack of risk-benefit long-term studies. Increased research in the male is mandatory to meet the requirements of the aging population. This should include the availability of precise epidemiological data about the frequency of partial androgen deficiency in aging males (PADAM).
机译:由于人口的发展,老龄男性将来需要更多考虑。与女性绝经期雌二醇迅速下降相反,男性的衰老过程受阻且个体差异较大。数十年来,观察到精子发生受损是一个连续的过程。但是,只有大约50%的男性在80多岁时表现出完全丧失了生育能力。原则上,精子发生可以很好地保留到衰老中。对于个体健康状况而言,重要的是,随着年龄的增长,莱迪希细胞的数量会减少。因此,衰老男性中性激素浓度的变化是由于功能紊乱和Leydig细胞逐渐减少所致。此外,垂体-性腺轴的反馈机制受损,昼夜节律性睾丸激素(T)节律消失。 LH和FSH水平升高,并且观察到性激素的生物利用度降低。 60岁以上男性体内总睾丸激素浓度降低,伴随着性能力降低的临床迹象,例如肌肉质量和强度降低,以及性毛生长和性欲降低。因此,与年龄有关的雄激素分泌和血浆睾丸激素水平下降表明使用雄激素补充剂。但是,缺乏长期的风险收益研究。为了满足老龄化人口的需求,必须加强对男性的研究。这应该包括可获得的关于老年男性部分雄激素缺乏症频率的精确流行病学数据(PADAM)。

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