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The Importance Of Androgen Resistance In The Testosterone Deficiency Syndrome
Central to the diagnosis and treatment of testosterone deficiency syndrome in the adult male is the remarkable paradox that there is very poor correlation between the characteristic symptoms and levels of serum androgens. The aim is to present an evidence-based working hypothesis to resolve this confusing clinical paradox. Methods A review of the possible mechanisms in testosterone deficiency syndrome was carried out and a hypothesis to explain this paradox and associated problems in the diagnosis and clinical management of androgen deficiency established on the basis of a review of the literature. Mechanisms by which androgen deficiency could arise were studied at five different levels: 1. Impaired androgen synthesis or regulation 2. Increased androgen binding 3. Reduced tissue responsiveness 4. Decreased androgen receptor activity. 5. Impaired transcription and translation. Results As with insulin in maturity onset diabetes mellitus, there can be both insufficient production, and variable degrees of resistance to the action of androgens operating at several levels in the body simultaneously, with these factors becoming progressively worse with aging, adverse life-style, other disease processes, and a wide range of medications. Conclusions Using this model, androgen deficiency can be redefined as an absolute or relative deficiency of androgens or their metabolites according to the needs of that individual at that time in his life. There are important ways in which the considerations raised by this hypothesis affect the causation, terminology, diagnosis and treatment of androgen deficient states.Using this model, androgen deficiency can be redefined as an absolute or relative deficiency of androgens or their metabolites according to the needs of that individual at that time in his life. There are important ways in which the considerations raised by this hypothesis affect the causation, terminology, diagnosis and treatment of androgen deficient states. Article Directory: http://www.articledashboard.com Dr Malcolm Carruthers is one of the very few UK based physicians who specialise in the diagnosis and treatment of testosterone deficiency. With a broad training in general and laboratory medicine, for the last twenty years he has specialised in Men's Health, andrology, particularly treating the Andropause aka Male Menopause. |
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