Morelli A, Corona G, Filippi S, Ambrosini S, Forti G, Vignozzi L, Maggi M
Andrology Unit, Department of Clinical Physiopathology, University of Florence, 50139 Florence, Italy.
J Endocrinol Invest. 2007 Nov;30(10):880-8. doi: 10.1007/BF03349232.
According to all the consensus and statements of the major societies, hypogonadism should be considered a medical problem, termed late onset hypogonadism (LOH) or testosterone deficiency syndrome (TDS), only when symptoms are present. One of the most common symptoms of LOH/TDS is sexual dysfunction (SD). The main purpose of this review is to discuss the role of testosterone (T) in men's sexual function, including epidemiology, pathophysiology, diagnostic procedures, and treatment efficacy in patients affected by erectile dysfunction (ED). The prevalence of hypogonadism in men with ED ranges from 1.7% to 35%. In ED patients, hypogonadism is often associated with reduced sexual desire and nocturnal penile erections, while association with sex-induced erection is less evident. This is because T regulates not only cyclic guanosine monophosphate (cGMP) formation, through nitric oxide synthase (NOS) stimulation, but also its catabolism, through phosphodiesterase-5 (PDE5) activity. The androgen-dependent PDE5 expression could explain the reduced effectiveness of PDE5 inhibitors (PDE5i) in the treatment of erectile dysfunction in hypogonadal patients. Accordingly, T substitution in these subjects restores responsiveness to PDE5i. Recognising hypogonadism in patients with ED is essential in order to appropriately treat the disease. However, suspecting LOH/TDS in SD patients is not an easy task. Recently published structured inventories, such as ANDROTEST, might help physicians to recognize hypogonadism and to further pursue its appropriate diagnosis and treatment.
根据主要学会的所有共识和声明，性腺功能减退仅在出现症状时才应被视为一种医学问题，称为迟发性性腺功能减退（LOH）或睾酮缺乏综合征（TDS）。LOH/TDS最常见的症状之一是性功能障碍（SD）。本综述的主要目的是讨论睾酮（T）在男性性功能中的作用，包括勃起功能障碍（ED）患者的流行病学、病理生理学、诊断程序和治疗效果。ED男性中性腺功能减退的患病率为1.7%至35%。在ED患者中，性腺功能减退常与性欲降低和夜间阴茎勃起减少有关，而与性刺激引起的勃起的关联则不太明显。这是因为T不仅通过刺激一氧化氮合酶（NOS）来调节环磷酸鸟苷（cGMP）的形成，还通过磷酸二酯酶5（PDE5）的活性来调节其分解代谢。雄激素依赖性PDE5表达可以解释PDE5抑制剂（PDE5i）在治疗性腺功能减退患者勃起功能障碍时效果降低的原因。因此，在这些患者中进行T替代可恢复对PDE5i 的反应性。识别ED患者的性腺功能减退对于适当治疗该疾病至关重要。然而，在SD患者中怀疑LOH/TDS并非易事。最近发表的结构化清单，如ANDROTEST，可能有助于医生识别性腺功能减退，并进一步进行适当的诊断和治疗。
