Miner Martin M, Sadovsky Richard
Department of Family Medicine, Brown University School of Medicine, Providence, RI, USA.
Cleve Clin J Med. 2007 May;74 Suppl 3:S38-46. doi: 10.3949/ccjm.74.suppl_3.s38.
Hypogonadism in men has a complex and varied pathogenesis. In addition to multiple established causes of the disease, low testosterone levels are associated with various comorbidities, including metabolic syndrome and type 2 diabetes. Symptoms associated with hypogonadism include reduced sex drive, fatigue, and mood disturbances, but accurate diagnosis requires biochemical testing. Total testosterone is considered the appropriate testosterone measurement in most situations in primary care, although free testosterone is a more accurate marker and is indicated in some situations. Testosterone replacement therapy is a valid treatment option for men with testosterone deficiency accompanied by symptoms of hypogonadism. The goals of therapy are to restore physiologic testosterone levels and alleviate symptoms. A potential association of testosterone replacement therapy with prostate cancer is the biggest safety concern, so patient monitoring should include regular digital rectal examination and prostate-specific antigen tests.
男性性腺功能减退的发病机制复杂多样。除了多种已明确的病因外，睾酮水平低下还与包括代谢综合征和2型糖尿病在内的各种合并症相关。与性腺功能减退相关的症状包括性欲减退、疲劳和情绪障碍，但准确诊断需要进行生化检测。在初级保健的大多数情况下，总睾酮被认为是合适的睾酮测量指标，尽管游离睾酮是更准确的标志物，在某些情况下适用。睾酮替代疗法是治疗伴有性腺功能减退症状的睾酮缺乏男性的有效选择。治疗目标是恢复生理睾酮水平并缓解症状。睾酮替代疗法与前列腺癌之间的潜在关联是最大的安全问题，因此患者监测应包括定期直肠指检和前列腺特异性抗原检测。
