Okun Michael S, Walter Benjamin L, McDonald William M, Tenover Joyce L, Green Joanne, Juncos Jorge L, DeLong Mahlon R
Department of Neurology, Emory University, Atlanta, Ga., USA.
Arch Neurol. 2002 Nov;59(11):1750-3. doi: 10.1001/archneur.59.11.1750.
To investigate whether a single daily dose of testosterone replacement gel has beneficial effects on testosterone deficiency symptoms, cognitive function, nonmotor symptoms of Parkinson disease (PD), and motor symptoms of PD.
Recently it has been observed that testosterone replacement therapy improves refractory nonmotor symptoms in testosterone-deficient men with PD. Many of the symptoms of testosterone deficiency are nonspecific and overlap with the nonmotor symptoms of PD, such as decreased enjoyment of life, lack of energy, sexual dysfunction, and depression. Replacement therapy for men with PD and comorbid testosterone deficiency may be an important addition to antiparkinsonian management strategies.
A prospective open-labeled pilot study of testosterone topical gel (5 g of AndroGel; Unimed Pharmaceutical Inc, Deerfield, Ill) administered daily to testosterone-deficient (free testosterone <80 pg/mL) men with PD. All 10 patients were followed up for 1 month and 6 patients were followed up for a total of 3 months. Patients were administered a battery of testosterone deficiency questionnaires, cognitive studies, and scales of PD nonmotor and motor function at baseline, 1, and 3 months.
With the daily transdermal testosterone gel, patients had an average increase in levels of free testosterone from baseline (53 pg/mL) to a 1-month follow-up visit (131 pg/mL; P =.06) and to a 3-month follow-up visit (98 pg/mL; P =.04). Testosterone deficiency symptoms improved in these patients (St Louis Testosterone Deficiency Questionnaire) from baseline (7.9 deficiency symptoms) to 1 month (5.6 deficiency symptoms, P =.04) and 3 months (5.8 deficiency symptoms, P =.08). The Unified Parkinson's Disease Rating Scale IV showed improvement at 1 month (P =.008). Additionally, there were trends toward improvement in the following scales: Unified Parkinson's Disease Rating Scale I at the 3-month follow-up (P =.09), Letter Fluency at the 3-month follow-up (P =.08), and the Hamilton Anxiety Scale at the 1-month follow-up (P =.09).
A daily dose of transdermal testosterone gel improved testosterone deficiency symptoms in men with PD. Although there were trends in improvement in other nonmotor and motor symptoms of PD, future placebo control studies will need to be powered to answer these important questions. Whether testosterone deficiency is simply a comorbidity in PD or whether it plays a role in the pathogenesis of disease also remains for future study.
探讨每日单剂量睾酮替代凝胶对睾酮缺乏症状、认知功能、帕金森病（PD）非运动症状及运动症状是否有有益影响。
最近观察到，睾酮替代疗法可改善睾酮缺乏的PD男性患者的难治性非运动症状。睾酮缺乏的许多症状是非特异性的，与PD的非运动症状重叠，如生活乐趣降低、缺乏精力、性功能障碍和抑郁。对合并睾酮缺乏的PD男性患者进行替代治疗可能是抗帕金森病管理策略的重要补充。
一项前瞻性开放标签的试点研究，对睾酮缺乏（游离睾酮<80 pg/mL）的PD男性患者每日给予睾酮外用凝胶（5 g的AndroGel；Unimed制药公司，伊利诺伊州迪尔菲尔德）。所有10例患者随访1个月，6例患者共随访3个月。在基线、1个月和3个月时，对患者进行一系列睾酮缺乏问卷、认知研究以及PD非运动和运动功能量表评估。
使用每日经皮睾酮凝胶后，患者游离睾酮水平从基线时的平均53 pg/mL升至1个月随访时的131 pg/mL（P = 0.06）以及3个月随访时的98 pg/mL（P = 0.04）。这些患者的睾酮缺乏症状（圣路易斯睾酮缺乏问卷）从基线时的7.9个缺乏症状改善至1个月时的5.6个缺乏症状（P = 0.04）以及3个月时的5.8个缺乏症状（P = 0.08）。统一帕金森病评定量表IV在1个月时显示改善（P = 0.008）。此外，在以下量表方面有改善趋势：3个月随访时统一帕金森病评定量表I（P = 0.09）、3个月随访时字母流畅性（P = 0.08）以及1个月随访时汉密尔顿焦虑量表（P = 0.09）。
每日剂量的经皮睾酮凝胶可改善PD男性患者的睾酮缺乏症状。尽管PD的其他非运动和运动症状有改善趋势，但未来需要进行安慰剂对照研究来回答这些重要问题。睾酮缺乏在PD中仅仅是一种合并症还是在疾病发病机制中起作用也有待未来研究。
