Traish Abdulmaged M, Goldstein Irwin, Kim Noel N
Department of Biochemistry, Boston University School of Medicine, Boston, MA 02118, USA.
Eur Urol. 2007 Jul;52(1):54-70. doi: 10.1016/j.eururo.2007.02.034. Epub 2007 Feb 20.
Androgens are essential for the development and growth of the penis, and they regulate erectile physiology by multiple mechanisms. Our goal is to provide a concise overview of the basic research and how this knowledge can be translated into a new clinical paradigm for patient management. In addition, this new paradigm may serve as a basis for stimulating constructive debate regarding the use of testosterone in men, and to promote new, innovative basic and clinical research to further understand the underlying mechanisms of androgen action in restoring erectile physiology.
A literature review was performed utilizing the US National Library of Medicine's PubMed database.
On the basis of evidence derived from laboratory animal studies and clinical data, we postulate that androgen insufficiency disrupts cellular-signaling pathways and produces pathologic alterations in penile tissues, leading to erectile dysfunction. In this review, we discuss androgen-dependent cellular, molecular, and physiologic mechanisms modulating erectile function in the animal model, and the implication of this knowledge in testosterone use in the clinical setting to treat erectile dysfunction. The new clinical paradigm incorporates many of the consensed points of view discussed in traditional consensed algorithms exclusively designed for men with androgen insufficiency. There are, however, novel and innovative differences with this new clinical paradigm. This paradigm represents a fresh effort to provide mandatory and optional management strategies for men with both androgen insufficiency and erectile dysfunction.
The new clinical paradigm is evidence-based and represents one of the first attempts to address a logical management plan for men with concomitant hormonal and sexual health concerns.
雄激素对于阴茎的发育和生长至关重要，并且它们通过多种机制调节勃起生理。我们的目标是简要概述基础研究，以及如何将这些知识转化为用于患者管理的新临床模式。此外，这种新模式可能成为激发关于男性使用睾酮的建设性辩论的基础，并促进新的、创新性的基础和临床研究，以进一步了解雄激素作用于恢复勃起生理的潜在机制。
利用美国国立医学图书馆的PubMed数据库进行文献综述。
基于来自动物实验研究和临床数据的证据，我们推测雄激素不足会破坏细胞信号通路，并在阴茎组织中产生病理改变，从而导致勃起功能障碍。在本综述中，我们讨论了动物模型中调节勃起功能的雄激素依赖性细胞、分子和生理机制，以及这些知识在临床环境中使用睾酮治疗勃起功能障碍方面的意义。新的临床模式纳入了专门为雄激素不足男性设计的传统共识算法中讨论的许多共识观点。然而，这种新的临床模式存在新颖和创新的差异。该模式代表了为患有雄激素不足和勃起功能障碍的男性提供强制性和可选管理策略的新尝试。
新的临床模式是基于证据的，并且是首次尝试为同时存在激素和性健康问题的男性制定合理管理计划之一。
