Araujo Andre B, Esche Gretchen R, Kupelian Varant, O'Donnell Amy B, Travison Thomas G, Williams Rachel E, Clark Richard V, McKinlay John B
New England Research Institutes, 9 Galen Street, Watertown, Massachusetts 02472, USA.
J Clin Endocrinol Metab. 2007 Nov;92(11):4241-7. doi: 10.1210/jc.2007-1245. Epub 2007 Aug 14.
Despite recognition that androgen deficiency in men should be defined according to biochemical and clinical criteria, most prevalence estimates are based on low testosterone levels alone.
The objective of this study was to examine the association between symptoms of androgen deficiency and low total and calculated free testosterone levels and estimate the prevalence of symptomatic androgen deficiency in men.
This study was a population-based, observational survey.
A total of 1,475 Black, Hispanic, and white men, between the ages of 30-79 yr, with complete data on testosterone, SHBG, and symptoms of androgen deficiency, and who are not taking medications that impact sex steroid levels were randomly selected from the Boston Area Community Health Survey.
Outcomes were measured as symptomatic androgen deficiency, defined as low total (<300 ng/dl) and free (<5 ng/dl) testosterone plus presence of low libido, erectile dysfunction, osteoporosis or fracture, or two or more of following symptoms: sleep disturbance, depressed mood, lethargy, or diminished physical performance.
Mean age of the sample was 47.3 +/- 12.5 yr. Approximately 24% of subjects had total testosterone less than 300 ng/dl, and 11% of subjects had free testosterone less than 5 ng/dl. Prevalence of symptoms were as follows: low libido (12%), erectile dysfunction (16%), osteoporosis/fracture (1%), and two or more of the nonspecific symptoms (20%). Low testosterone levels were associated with symptoms, but many men with low testosterone levels were asymptomatic (e.g. in men 50+ yr, 47.6%). Crude prevalence of symptomatic androgen deficiency was 5.6% (95% confidence interval: 3.6%, 8.6%), and was not significantly related to race and ethnic group. Prevalence was low in men less than 70 yr (3.1-7.0%) and increased markedly with age to 18.4% among 70 yr olds. Projection of these estimates to the year 2025 suggests that there will be as many as 6.5 million American men ages 30-79 yr with symptomatic androgen deficiency, an increase of 38% from 2000 population estimates.
Prevalence of symptomatic androgen deficiency in men 30 and 79 yr of age is 5.6% and increases substantially with age. The aging of the U.S. male population will cause a large increase in the burden of symptomatic androgen deficiency. Future work should address the clinical significance of low testosterone levels in asymptomatic men.
尽管人们认识到男性雄激素缺乏应根据生化和临床标准来定义，但大多数患病率估计仅基于低睾酮水平。
本研究的目的是探讨雄激素缺乏症状与总睾酮及计算得出的游离睾酮水平低下之间的关联，并估计男性有症状的雄激素缺乏的患病率。
本研究是一项基于人群的观察性调查。
从波士顿地区社区健康调查中随机选取了1475名年龄在30 - 79岁之间的黑人、西班牙裔和白人男性，他们有关于睾酮、性激素结合球蛋白（SHBG）和雄激素缺乏症状的完整数据，且未服用影响性类固醇水平的药物。
以有症状的雄激素缺乏作为衡量指标，定义为总睾酮水平低（<300 ng/dl）且游离睾酮水平低（<5 ng/dl），同时伴有性欲低下、勃起功能障碍、骨质疏松或骨折，或出现以下两种或更多症状：睡眠障碍、情绪低落、无精打采或身体机能下降。
样本的平均年龄为47.3±12.5岁。约24%的受试者总睾酮水平低于300 ng/dl，11%的受试者游离睾酮水平低于5 ng/dl。症状的患病率如下：性欲低下（12%）、勃起功能障碍（16%）、骨质疏松/骨折（1%）以及两种或更多非特异性症状（20%）。低睾酮水平与症状相关，但许多睾酮水平低的男性并无症状（例如50岁及以上男性中，无症状者占47.6%）。有症状的雄激素缺乏的粗患病率为5.6%（95%置信区间：3.6%，8.6%），且与种族和族裔群体无显著相关性。70岁以下男性的患病率较低（3.1 - 7.0%），而70岁男性的患病率显著上升至18.4%。将这些估计值推算至2025年表明，将有多达650万年龄在30 - 79岁之间的美国男性患有有症状的雄激素缺乏，比2000年的人群估计数增加38%。
30至79岁男性中有症状的雄激素缺乏的患病率为5.6%，且随年龄大幅增加。美国男性人口的老龄化将导致有症状的雄激素缺乏负担大幅增加。未来的工作应关注无症状男性低睾酮水平的临床意义。
