Andrology Unit, Department of Clinical Physiopathology, University of Florence, Florence Italy.
J Sex Med. 2010 Apr;7(4 Pt 1):1547-56. doi: 10.1111/j.1743-6109.2009.01698.x. Epub 2010 Feb 5.
Previous clinical studies on effect of statins treatment on testosterone (T) levels have produced mixed results.
The aim of the present study is to evaluate the association between statin therapy and hormonal parameters in a large series of subjects seeking medical care at our unit for erectile dysfunction (ED).
A consecutive series of 3,484 (mean age 51.6 + or - 13.1 years) patients with ED was studied.
Several hormonal and biochemical parameters were investigated, along with ANDROTEST structured interview measuring hypogonadism-related symptoms.
Among the patients studied, 244 (7%) patients were being treated with statins. After adjustment for confounding factors (including body mass index and Progetto Cuore cardiovascular (CV) risk engine score), both total and calculated free testosterone levels were significantly lower in subjects taking statins, when compared to the rest of the sample (hazard ratio [HR] = 0.93 [0.90; 0.96] and 0.26 [0.01; 0.18] for each decrement of total T and calculated free T, respectively; both P < 0.0001). The use of statins was also associated with a reduced testis volume and a higher prevalence of hypogonadism-related symptoms and signs, as assessed by higher ANDROTEST score (HR = 1.12 [1.03; 1.21]; P < 0.01 after adjustment for confounders). Follicle-stimulating hormone levels were significantly higher in subjects treated with statins when compared to the rest of the sample, while there was a trend toward higher luteinizing hormone levels, but this did not reach statistical significance. The lower levels of total and calculated free T observed in subjects treated with statins were also confirmed comparing them with age-waist circumference and CV risk score matched controls. Finally, subjects being treated with statins showed lower prolactin levels when compared to the rest of the sample.
Our data demonstrated that statin therapy might induce an overt primary hypogonadism and should be considered as a possible confounding factor for the evaluation of testosterone levels in patients with ED.
先前关于他汀类药物治疗对睾酮（T）水平影响的临床研究结果不一。
本研究旨在评估他汀类药物治疗与我们单位就诊的勃起功能障碍（ED）患者大量系列人群的激素参数之间的关联。
研究了连续 3484 名（平均年龄 51.6+/-13.1 岁）ED 患者。
同时进行雄激素测试（ANDROTEST）结构访谈，以评估与性腺功能减退相关的症状，调查了多种激素和生化参数。
在所研究的患者中，244 名（7%）患者正在接受他汀类药物治疗。在校正混杂因素（包括体重指数和普罗托库雷心血管（CV）风险引擎评分）后，与样本中的其余患者相比，服用他汀类药物的患者的总睾酮和计算的游离睾酮水平明显降低（风险比[HR]分别为 0.93[0.90；0.96]和 0.26[0.01；0.18]；P<0.0001）。他汀类药物的使用也与睾丸体积减小、更高的性腺功能减退相关症状和体征发生率相关，这是通过更高的 ANDROTEST 评分评估的（HR=1.12[1.03；1.21]；P<0.01，校正混杂因素后）。与样本中的其余患者相比，服用他汀类药物的患者的卵泡刺激素水平明显更高，而黄体生成素水平有升高趋势，但未达到统计学意义。与年龄-腰围和 CV 风险评分匹配的对照组相比，服用他汀类药物的患者观察到的总睾酮和计算的游离睾酮水平较低也得到了证实。最后，与样本中的其余患者相比，服用他汀类药物的患者的催乳素水平较低。
我们的数据表明，他汀类药物治疗可能导致明显的原发性性腺功能减退症，应被视为 ED 患者睾酮水平评估的一个可能混杂因素。
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