Schubert M, Jockenhövel F
Klinik II für Innere Medizin, Universität zu Köln, Köln.
Urologe A. 2010 Jan;49(1):47-50. doi: 10.1007/s00120-009-2198-7.
Abdominal obesity as a key cardiovascular risk factor as well as metabolic syndrome and type 2 diabetes mellitus are associated with low testosterone levels. In line with these facts, investigations of patients undergoing androgen ablation therapy for prostate cancer have shown a negative effect of this treatment approach on insulin sensitivity and body fat mass. The effects of physiological doses of testosterone seem to have less impact on the parameters of lipid metabolism. However, supraphysiological levels of testosterone can lower HDL levels. At present data on glycemic control in patients with type 2 diabetes are not yet uniform, but negative effects on glycemic control in type 2 diabetics have not been reported. In fact two studies were able to demonstrate a positive effect of testosterone on glycemic control in patients with type 2 diabetes. It is currently not yet possible to conclusively evaluate the significance of testosterone treatment in patients with metabolic syndrome and type 2 diabetes mellitus. Only larger, randomized prospective trials will show whether testosterone therapy is helpful in metabolic syndrome or type 2 diabetes. However, administration of testosterone in hypogonadal men with metabolic syndrome appears to be a promising treatment option to improve metabolic control.
腹部肥胖作为关键的心血管危险因素，以及代谢综合征和2型糖尿病，均与低睾酮水平相关。基于这些事实，对接受前列腺癌雄激素消融治疗的患者进行的调查显示，这种治疗方法对胰岛素敏感性和体脂量有负面影响。生理剂量的睾酮对脂质代谢参数的影响似乎较小。然而，超生理水平的睾酮会降低高密度脂蛋白水平。目前，关于2型糖尿病患者血糖控制的数据尚不统一，但尚未有关于睾酮对2型糖尿病患者血糖控制产生负面影响的报道。事实上，有两项研究能够证明睾酮对2型糖尿病患者的血糖控制有积极作用。目前尚无法最终评估睾酮治疗在代谢综合征和2型糖尿病患者中的意义。只有更大规模的随机前瞻性试验才能表明睾酮治疗对代谢综合征或2型糖尿病是否有帮助。然而，对患有代谢综合征的性腺功能减退男性给予睾酮似乎是改善代谢控制的一种有前景的治疗选择。
