Kaufman Jean M, Vermeulen Alex
Department of Endocrinology, Ghent University Hospital, Ghent B-9000, Belgium.
Endocr Rev. 2005 Oct;26(6):833-76. doi: 10.1210/er.2004-0013. Epub 2005 May 18.
Aging in men is accompanied by a progressive, but individually variable decline of serum testosterone production, more than 20% of healthy men over 60 yr of age presenting with serum levels below the range for young men. Albeit the clinical picture of aging in men is reminiscent of that of hypogonadism in young men and decreased testosterone production appears to play a role in part of these clinical changes in at least some elderly men, the clinical relevancy of the age-related decline in sex steroid levels in men has not been unequivocally established. In fact, minimal androgen requirements for elderly men remain poorly defined and are likely to vary between individuals. Consequently, borderline androgen deficiency cannot be reliably diagnosed in the elderly, and strict differentiation between "substitutive" and "pharmacological" androgen administration is not possible. To date, only a few hundred elderly men have received androgen therapy in the setting of a randomized, controlled study, and many of these men were not androgen deficient. Most consistent effects of treatment have been on body composition, but to date there is no evidence-based documentation of clinical benefits of androgen administration to elderly men with normal or moderately low serum testosterone in terms of diminished morbidity or of improved survival or quality of life. Until the long-term risk-benefit ratio for androgen administration to elderly is established in adequately powered trials of longer duration, androgen administration to elderly men should be reserved for the minority of elderly men who have both clear clinical symptoms of hypogonadism and frankly low serum testosterone levels.
男性衰老伴随着血清睾酮分泌逐渐减少，但个体差异较大，超过20%的60岁以上健康男性血清睾酮水平低于年轻男性的正常范围。尽管男性衰老的临床表现让人联想到年轻男性性腺功能减退的表现，且睾酮分泌减少似乎在至少部分老年男性的这些临床变化中起了一定作用，但男性性激素水平随年龄下降的临床相关性尚未明确确立。事实上，老年男性的最低雄激素需求仍未明确界定，且可能因人而异。因此，老年男性临界雄激素缺乏无法得到可靠诊断，“替代”和“药理”雄激素给药之间也无法严格区分。迄今为止，只有几百名老年男性在随机对照研究中接受了雄激素治疗，其中许多人并非雄激素缺乏。治疗最一致的效果体现在身体组成方面，但迄今为止，尚无基于证据的文件证明，对血清睾酮正常或略低的老年男性给予雄激素能在降低发病率、提高生存率或改善生活质量方面带来临床益处。在足够规模、持续时间更长的试验确定老年男性使用雄激素的长期风险效益比之前，雄激素给药应仅适用于少数既有明显性腺功能减退临床症状又有明显低血清睾酮水平的老年男性。
