Outros efeitos relacionados à terapia

Apnéia do sono, ginecomastia, acne e hepatotoxicidade também são efeitos adversos que podem estar relacionados à TRT (GOOREN, 2006; GRUENEWALD; MATSUMOTO, 2003). Em geral, poucos estudos relatam a ocorrência desses efeitos, e quando ocorrem, em geral, acometem um reduzido número de pacientes (HAJJAR et al., 1997; HAREN et al., 2005; MORALES et al. 1997; TENOVER, 1997).

47 Existem relatos demonstrando que a terapia com testosterona pode piorar apnéia do sono obstrutiva pré-existente. Todavia, essa relação ainda é mal compreendida. Um estudo controlado, com duração de três anos, com uma amostra composta de cerca de 100 homens idosos, não observou nenhum aumento nos episódios de apnéia (TENOVER, 1997).

Outro efeito que é ocasionalmente obsevado é o desenvolvimento das mamas, e parece que homens mais velhos são mais propensos (TENOVER, 2003). Morales et al. (1997), identificaram apenas um paciente com efeitos na mama e desenvolvimento de acne. Além disso, esses eventos são mais frequentes quando se atinge níveis séricos muito elevados de testosterona, comuns com a administração de ésteres de testosterona injetáveis ou com implantes subdérmicos. Não obstante, são reações adversas facilmente controladas com ajuste de dose ou substituição da forma farmacêutica empregada (TENOVER, 2003).

A ocorrência da hepatotoxicidade, por sua vez, está mais relacionada ao uso das preparações orais, sendo que estas estão em desuso (EMMELOT-VONK, et al. 2008).

48 7 CONSIDERAÇÕES FINAIS

Baseando-se nos achados disponíveis sobre a terapia de reposição androgênica em homens idosos com hipogonadismo tardio, o estudo permitiu identificar como evidências:

 A terapia de reposição de testosterona em homens idosos com hipogonadismo tardio parece exercer efeitos benéficos como a restauração da massa óssea, força muscular e composição corporal, restauração da libido, função sexual, melhorias relacionadas ao humor e percepção de qualidade de vida, e ainda, esses efeitos são melhores observados em homens que apresentam níveis mais baixos de testosterona;

 O risco de policitemia está bem estabelecido, no entanto, ainda não há um consenso sobre os efeitos da reposição no sistema cardiovascular e em eventos relacionados à próstata. Necessita-se da realização de um grande estudo clínico, multicêntrico, que avalie especificamente esses eventos a longo prazo;

 Efeitos como apnéia do sono, acne e ginecomastia são incomuns e facilmente controlados com ajuste de dose ou substituição da forma farmacêutica, e a hepatotoxicidade está limitada aos agentes orais;

 Viu-se que devido a conveniência e, principalmente, devido a obtenção de níveis hormonais satisfatórios, as preparações transdérmicas, têm sido apontadas como excelentes alternativas a serem utilizadas no tratamento. No entanto, atualmente as preparações farmacêuticas mais utilizadas pela maioria dos pacientes ainda são as injeções intramusculares.

 A terapia somente está indicada em homens idosos sintomáticos. Quando os efeitos da deficiência androgênica geram efeitos em tal proporção capaz de afetar a qualidade de vida no paciente. O diagnóstico do hipogonadismo tardio deve ser baseado na associação de sinais e sintomas específicos e níveis séricos de testosterona abaixo dos valores de referência para a faixa etária;

 Até que sejam elucidadas todas as questões, a TRT permanece contraindicada em pacientes com câncer de próstata, hiperviscosidade,

49 eritrocitose, apnéia obstrutiva do sono não tratada e insuficiência cardíaca grave.

 No entanto, o presente trabalho conta com algumas limitações. Ressalta-se que só foram incluídos na revisão aqueles artigos disponíveis pelo Virtual Private Network (VPN) da Universidade de Brasília (UnB) e que a pesquisa foi realizada apenas nas bases de dados PubMed e SciELO. Assim, para se obter resultados mais representativos sobre a TRT, existe a necessidade da relização de uma revisão sistemática, com a busca em mais bases de dados, e ainda, a análise da qualidade das evidências apresentadas.

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