Experience in the combined use of testosterone and L-arginine in men with sexual dysfunctions and androgen deficiency

At present, the problem of androgen deficiency in men is sufficiently studied taking into account the age aspect of this pathology. At the same time, the data of some epidemiological studies indicate its prevalence among young people. Thus, the number of men with androgen deficiency at the age of 20-29 years in the UK is 2-3%, 40-49 years - 10% of the total number of patients. In the US, 5% of young men aged 30-39 years have symptoms of this pathology, and in Canada, 14.2% of men under 39 years of age receive androgen therapy.

According to the recommendations of the European Endocrinology Association, the diagnosis of androgen deficiency is established in the case of the presence of specific or nonspecific symptoms and signs, which are accompanied by an unambiguous decrease in testosterone (T) levels in the blood. One of the specific symptoms is sexual dysfunction, in particular the reduction of libido (SL) and sexual activity, as well as adequate erections. In addition, a number of authors in the concept of androgen deficiency include the reduction of biologically active fractions of testosterone and consider all variants of erectile dysfunction (ED) as specific manifestations of androgen deficiency.

Our previous studies made it possible to establish that among some young men without clinical signs of hypogonadism, in addition to these disorders, one of the most common forms of sexual dysfunction (SD), premature ejaculation (PS), is noted against hypothyroidism.

One of the options for therapy in this case is the administration of testosterone preparations. In addition, it is sometimes recommended to combine this therapy with the prescription of drugs of the group of inhibitors of phosphodiesterase type 5 (PDE-5) to enhance the therapeutic effect, in particular in elderly men. The use of such therapeutic regimens in young men had a more pronounced therapeutic effect, as evidenced by our previous studies.

To date, some authors singled out as one of the criteria for the successful treatment of hypogonadism, which is a classic manifestation of androgen deficiency, normalization of the nitrogen balance. It has been established that in men with hypogonadotropic hypogonadism, the level of the conditionally indispensable amino acid L-arginine (L-Apr) required for the synthesis of nitric oxide (NO) is higher in the blood, and NO is lower than in practically healthy men, and against the background of testosterone therapy an increase in the concentration of NO in the blood and a decrease in the concentration of L-arginine.

In another study, it was found that the concentration of L-arginine in cavernous blood is significantly lower in men with erectile dysfunction than in practically healthy individuals. This is also significant for vascular supply of erectile function, as evidenced by the involvement of testosterone in the activation of the NOS enzyme necessary to stimulate the release of NO from the cavernous bodies of the penis.

Experimental data showed that the combined use of testosterone and L-arginine leads to an increase in intracavernous pressure in castrated rats, despite the competing interaction of L-arginine and NOS, which is explained by the existence of other androgen-dependent mechanisms of vascular supply of the erection.

At the same time, the effect of this complex therapy on sexual dysfunction in young men with androgen deficiency has not been studied to date, which was the goal of our study.

Under the supervision of the andrology office, there were 34 men aged 22-42 years who, against a background of a decrease in total testosterone (T total), corresponding to the boundary values (8.0-12.0 nmol / L), and a decrease in free testosterone levels (T c) below 31.0 pmol / l, androgen deficiency was diagnosed. There were complaints about erectile dysfunction, premature ejaculation and decreased libido, which allowed to consider them as manifestations of androgen deficiency. 26 of the examined patients had a combined pathology (a combination of erectile dysfunction and decreased libido or erectile dysfunction and premature ejaculation), and 8 had monopathology.

As a control group, 21 men with a normal state of sexual function (SF) and normotestosteronemia were examined.

All patients were recommended to apply on the shoulder area 1% gel of testosterone 5 g once a day in the morning in combination with an L-arginine-containing dietary supplement recommended for use in diets for men as an additional source of amino acids, nicotinic acid and fructose, 1 packet once a day in the morning for one month. The composition of this additive includes: L-arginine - 2500 mg, fructose - 1375 mg, propionyl-b-carnitine -250 mg and vitamin B3 - 20 mg. In addition to the above listed key properties of L-arginine, this combination of nutrients has metabolic and antioxidant properties, which is essential in conditions of hypoandrogenemia.

Andrological status in all patients was studied according to the generally accepted method.

The diagnosis of premature ejaculation was established on the basis of measuring the duration of the sexual intercourse, which according to the existing recommendations in healthy men exceeds one minute.

The levels of total T total and T cv in the blood were determined with the help of sets for enzyme immunoassay.

Before the beginning and a month after the treatment, we studied the state of sexual function on the basis of anamnesis, complaints, as well as the analysis of the results of the questionnaire "International Index of Erectile Function" (ICEF-15) and the study of the duration of sexual intercourse.

Statistical processing of the obtained data was carried out with the help of the Statistica application package using the Student's test and the x2 method.

The clinical examination did not reveal hypogonadism, traumatic, inflammatory lesions of genital organs, varicocele, pathology of the central nervous system, mental illnesses and severe somatic pathology, that is, conditions that may be accompanied by hypoandrogenemia and / or influence the results of the study. They also did not take medications that could affect the state of sexual function.

Data from the hormonal examination made it possible to establish a decrease in the T levels in 34 men (the mean values were 10.8 ± 0.8 nmol / L), and T c - in 21 men (8.1 ± 0.9 pg / ml), and in In accordance with the recommendations, androgen therapy was prescribed in case of a decrease in T total or both androgens. The T and T levels in the men in the control group were within the normal range and were significantly higher than in the main group (22.3 ± 1.4 nmol / L and 88.0 ± 7.0 pg / ml, respectively, p <0.001 ).

These results of the ICEF-15 questionnaire, which characterize the investigated symptoms, and the total index determining the state of sexual function as a whole, made it possible to establish a significant increase in the score at the end of therapy as compared with before treatment, which did not differ significantly from the control values.

At the end of therapy against the background of normalization of androgen levels in the blood, in all men the restoration of erectile function and libido, as well as the increase in the duration of the sexual intercourse, was noted in the vast majority of men, which indicated a significant effect of this therapy. In our opinion, the use of L-arginine, which is an NO donor, is necessary for timely replenishment and normalization of nitrogen balance in the body in conditions of increasing concentration and can be considered as a variant of dietary supplementation in the treatment of sexual dysfunctions in young men with androgen deficiency.

Thus, the combined use of testosterone and L-arginine-containing dietary supplement for food for one month in men with sexual dysfunction and androgen deficiency in most cases leads to a normalization in them of the state of sexual function.

Cand. Honey. The science. S. Minukhin, Doctor of Science. Honey. Science in. A. Bondarenko, prof. E. V. Krishtal. Experience in the combined use of testosterone and L-arginine in young men with sexual dysfunction and androgen deficiency // International Medical Journal - №4 - 2012

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