Bhasin Shalender, Cunningham Glenn R, Hayes Frances J, Matsumoto Alvin M, Snyder Peter J, Swerdloff Ronald S, Montori Victor M
Boston University School of Medicine (S.B.), Boston, Massachusetts 02118, USA.
J Clin Endocrinol Metab. 2006 Jun;91(6):1995-2010. doi: 10.1210/jc.2005-2847. Epub 2006 May 23.
The objective was to provide guidelines for the evaluation and treatment of androgen deficiency syndromes in adult men.
The Task Force was composed of a chair, selected by the Clinical Guidelines Subcommittee of The Endocrine Society, five additional experts, a methodologist, and a professional writer. The Task Force received no corporate funding or remuneration.
The Task Force used systematic reviews of available evidence to inform its key recommendations. The Task Force used consistent language and graphical descriptions of both the strength of recommendation and the quality of evidence, using the recommendations of the Grading of Recommendations, Assessment, Development, and Evaluation group.
Consensus was guided by systematic reviews of evidence and discussions during three group meetings, several conference calls, and e-mail communications. The drafts prepared by the panelists with the help of a professional writer were reviewed successively by The Endocrine Society's Clinical Guidelines Subcommittee, Clinical Affairs Committee, and Council. The version approved by the Council was placed on The Endocrine Society's web site for comments by members. At each stage of review, the Task Force received written comments and incorporated needed changes.
We recommend making a diagnosis of androgen deficiency only in men with consistent symptoms and signs and unequivocally low serum testosterone levels. We suggest the measurement of morning total testosterone level by a reliable assay as the initial diagnostic test. We recommend confirmation of the diagnosis by repeating the measurement of morning total testosterone and in some patients by measurement of free or bioavailable testosterone level, using accurate assays. We recommend testosterone therapy for symptomatic men with androgen deficiency, who have low testosterone levels, to induce and maintain secondary sex characteristics and to improve their sexual function, sense of well-being, muscle mass and strength, and bone mineral density. We recommend against starting testosterone therapy in patients with breast or prostate cancer, a palpable prostate nodule or induration or prostate-specific antigen greater than 3 ng/ml without further urological evaluation, erythrocytosis (hematocrit > 50%), hyperviscosity, untreated obstructive sleep apnea, severe lower urinary tract symptoms with International Prostate Symptom Score (IPSS) greater than 19, or class III or IV heart failure. When testosterone therapy is instituted, we suggest aiming at achieving testosterone levels during treatment in the mid-normal range with any of the approved formulations, chosen on the basis of the patient's preference, consideration of pharmacokinetics, treatment burden, and cost. Men receiving testosterone therapy should be monitored using a standardized plan.
旨在为成年男性雄激素缺乏综合征的评估和治疗提供指导方针。
特别工作组由一名主席（由内分泌学会临床指南小组委员会选定）、另外五名专家、一名方法学家和一名专业撰写人员组成。特别工作组未接受任何企业资助或报酬。
特别工作组利用对现有证据的系统评价来为其关键建议提供依据。特别工作组采用了推荐分级、评估、制定与评价小组的建议中关于推荐强度和证据质量的一致语言及图形描述。
共识的达成以证据的系统评价以及三次小组会议、多次电话会议和电子邮件交流中的讨论为指导。由小组成员在专业撰写人员协助下起草的草案先后由内分泌学会临床指南小组委员会、临床事务委员会和理事会进行评审。理事会批准的版本发布在内分泌学会网站上供会员评论。在每个评审阶段，特别工作组都收到书面意见并做出必要修改。
我们建议仅对有持续症状和体征且血清睾酮水平明确降低的男性诊断雄激素缺乏。我们建议采用可靠检测方法测量清晨总睾酮水平作为初始诊断检测。我们建议通过重复测量清晨总睾酮以及在某些患者中采用准确检测方法测量游离或生物可利用睾酮水平来确诊。我们建议对有症状且睾酮水平低的雄激素缺乏男性进行睾酮治疗，以诱导和维持第二性征并改善其性功能、幸福感、肌肉量和力量以及骨矿物质密度。我们建议在未进行进一步泌尿外科评估的情况下，不对患有乳腺癌或前列腺癌、可触及前列腺结节或硬结或前列腺特异性抗原大于3 ng/ml、红细胞增多症（血细胞比容>50%）、高黏滞血症、未经治疗的阻塞性睡眠呼吸暂停、国际前列腺症状评分（IPSS）大于19的严重下尿路症状或III或IV级心力衰竭的患者开始睾酮治疗。开始睾酮治疗时，我们建议根据患者偏好、药代动力学、治疗负担和成本选择任何一种获批制剂，使治疗期间睾酮水平达到正常范围的中位数。接受睾酮治疗的男性应按照标准化方案进行监测。
