Tenover J S
Wesley Woods Health Center, Atlanta, Georgia 30329, USA.
Int J Impot Res. 2003 Aug;15 Suppl 4:S3-8. doi: 10.1038/sj.ijir.3901029.
Age-related decline in male sex hormones, particularly testosterone, is referred to as andropause. Like menopause, andropause is associated with physical and emotional changes that may be alleviated by hormone replacement therapy. Hypogonadism in aging men, as defined by a low free testosterone index, is due to declining testosterone production and increased sex hormone-binding globulin levels. About 30% of men in their 60s and more than 80% of men over 80 y may have a low free testosterone index. Diagnosis of hypogonadism is based on clinical symptoms (eg, decreased muscle mass, fractures, loss of libido) and laboratory determinations of serum testosterone-usually total testosterone levels. Measuring bioavailable testosterone, or free testosterone, is expensive and time-consuming, but may more accurately detect hypogonadism. Testosterone replacement therapy is generally safe in aging men and may improve libido, cognition, bone mineral density, body mass composition, and serum lipoproteins. Although contraindicated in men with prostate or breast cancer, testosterone replacement therapy in aging men warrants examination. Any of the available testosterone formulations can be used, but injectable forms have certain advantages, including excellent dose adjustability, lack of skin irritation, and low cost.
男性性激素尤其是睾酮随年龄增长而下降被称为男性更年期。与女性更年期一样，男性更年期与身体和情绪变化有关，激素替代疗法可能会缓解这些变化。根据游离睾酮指数低来定义，老年男性性腺功能减退是由于睾酮分泌减少和性激素结合球蛋白水平升高所致。60多岁的男性中约30%以及80岁以上的男性中超过80%可能有低游离睾酮指数。性腺功能减退的诊断基于临床症状（如肌肉量减少、骨折、性欲丧失）以及血清睾酮的实验室测定——通常是总睾酮水平。测量生物可利用睾酮或游离睾酮成本高且耗时，但可能更准确地检测出性腺功能减退。睾酮替代疗法在老年男性中一般是安全的，可能会改善性欲、认知、骨矿物质密度、身体成分和血清脂蛋白。虽然前列腺癌或乳腺癌患者禁忌，但老年男性的睾酮替代疗法值得研究。任何可用的睾酮制剂都可以使用，但注射剂型有某些优点，包括剂量调节性极佳、无皮肤刺激且成本低。
