Zitzmann Michael, Faber Stephanie, Nieschlag Eberhard
Institute of Reproductive Medicine of the University, Domagkstr. 11, D-48129 Münster, Germany.
J Clin Endocrinol Metab. 2006 Nov;91(11):4335-43. doi: 10.1210/jc.2006-0401. Epub 2006 Aug 22.
Although attention and concern about health disorders in aging men have been growing, the structure of psychological and somatic complaints of actual patients, not population-based cohorts, has not been elucidated in relation to sex hormone patterns and metabolism.
The objective of the study was investigation of factors influencing complaint structures in aging male patients.
This was a cross-sectional cohort study.
The study was conducted in an andrological outpatient department.
Subjects included 434 consecutive male patients aged 50-86 yr.
The following hypotheses were measured: 1) psychosomatic complaints and metabolic factors in aging male patients are related to sex hormone levels in a symptom-specific manner, and 2) patients form subcohorts.
A clear-cut threshold for late-onset hypogonadism was not found; rather, prevalence of psychosomatic symptoms and metabolic risk factors accumulated with decreasing androgen levels. For example, androgen-induced prevalence of loss of libido or vigor increased below testosterone concentrations of 15 nmol/liter (P < 0.001), whereas depression and diabetes mellitus type 2 (also in nonobese men) were significantly more present in men with testosterone concentrations below 10 nmol/liter (P < 0.001). Erectile dysfunction was identified as a composite pathology of metabolic risk factors, smoking, and depressivity, whereas only testosterone concentrations below 8 nmol/liter contributed to that symptom (P = 0.003). Cluster analysis revealed aging men to present within three independent groups characterized by psychosomatic complaints, metabolic disorders, and sexual health problems. These subgroups of patients exhibit distinct features in terms of androgen levels, age, and body mass index.
There is no evidence that a uniform structure of testosterone concentrations and complaints exists within the cohort of elderly male patients. Rather, in aging male patients, psychosomatic complaints and metabolic risk relate to testosterone in a symptom-specific manner.
尽管对老年男性健康问题的关注日益增加，但实际患者（而非基于人群的队列）的心理和躯体症状结构与性激素模式及代谢之间的关系尚未阐明。
本研究的目的是调查影响老年男性患者症状结构的因素。
这是一项横断面队列研究。
研究在男科门诊进行。
研究对象包括434名年龄在50 - 86岁的连续男性患者。
对以下假设进行了测量：1）老年男性患者的心身症状和代谢因素以症状特异性方式与性激素水平相关，2）患者形成亚组。
未发现迟发性性腺功能减退的明确阈值；相反，心身症状和代谢危险因素的患病率随着雄激素水平的降低而累积。例如，雄激素导致的性欲或活力丧失患病率在睾酮浓度低于15 nmol/L时增加（P < 0.001），而在睾酮浓度低于10 nmol/L的男性中，抑郁症和2型糖尿病（非肥胖男性也如此）的发生率显著更高（P < 0.001）。勃起功能障碍被确定为代谢危险因素、吸烟和抑郁的复合病理表现，而只有睾酮浓度低于8 nmol/L才导致该症状（P = 0.003）。聚类分析显示老年男性分为三个独立组，其特征分别为心身症状、代谢紊乱和性健康问题。这些患者亚组在雄激素水平、年龄和体重指数方面表现出不同特征。
没有证据表明老年男性患者队列中存在睾酮浓度和症状的统一结构。相反，在老年男性患者中，心身症状和代谢风险以症状特异性方式与睾酮相关。
