Department of Medicine, University of Toronto, Division of Endocrinology and Metabolism, Mount Sinai Hospital, Toronto, Ontario, Canada.
Maturitas. 2010 May;66(1):16-22. doi: 10.1016/j.maturitas.2010.01.009. Epub 2010 Feb 13.
It is well-established that total testosterone (TT) in men decreases with age and that bioavailable testosterone (bio-T) falls to an even greater extent. The clinical relevance of declining androgens in the aging male and use of testosterone replacement therapy (TRT) in this situation is controversial. Most studies have been short term and there are no large randomized placebo-controlled trials. Testosterone has many physiological actions in: muscles, bones, hematopoietic system, brain, reproductive and sexual organs, adipose tissue. Within these areas it stimulates: muscle growth and maintenance, bone development while inhibiting bone resorption, the production of red blood cells to increase hemoglobin, libido, enhanced mood and cognition, erectile function and lipolysis. Anabolic deficits in aging men can induce: frailty, sarcopenia, poor muscle quality, muscle weakness, hypertrophy of adipose tissue and impaired neurotransmission. The aging male with reduced testosterone availability may present with a wide variety of symptoms which in addition to frailty and weakness include: fatigue, decreased energy, decreased motivation, cognitive impairment, decreased self-confidence, depression, irritability, osteoporotic pain and the lethargy of anemia. In addition, testosterone deficiency is also associated with type-2 diabetes, the metabolic syndrome, coronary artery disease, stroke and transient ischemic attacks, and cardiovascular disease in general. Furthermore, there are early studies to suggest that TRT in men with low testosterone levels may improve metabolic status by: lowering blood sugar and HbA1C in men with type-2 diabetes, reducing abdominal girth, ameliorating features of the metabolic syndrome, all of which may be protective of the cardiovascular system. The major safety issue is prostate cancer but there is no evidence that supports the idea that testosterone causes the development of a de novo cancer. So on balance in a man with symptoms of hygonadism and low or lowish levels of testosterone with no evidence of prostate cancer such as a normal PSA a therapeutic (4-6 months) trial of TRT is justified. Treatment and monitoring of this duration will determine whether the patient is responsive.
众所周知，男性的总睾酮（TT）随年龄增长而下降，而生物可利用睾酮（bio-T）的下降幅度更大。在衰老男性中，雄激素下降的临床意义以及在这种情况下使用睾酮替代疗法（TRT）存在争议。大多数研究都是短期的，没有大型的随机安慰剂对照试验。
肌肉、骨骼、造血系统、大脑、生殖和性器官、脂肪组织中具有许多生理作用。在这些领域，它刺激：肌肉生长和维持、骨骼发育，同时抑制骨吸收、红细胞生成以增加血红蛋白、性欲、改善情绪和认知、勃起功能和脂肪分解。衰老男性的合成代谢缺陷会导致：虚弱、肌肉减少症、肌肉质量差、肌肉无力、脂肪组织肥大和神经传递受损。
睾丸激素供应减少的老年男性可能会出现多种症状，除了虚弱和无力外，还包括：疲劳、能量下降、动力下降、认知障碍、自信心下降、抑郁、易怒、骨质疏松性疼痛和贫血引起的倦怠。此外，睾酮缺乏还与 2 型糖尿病、代谢综合征、冠状动脉疾病、中风和短暂性脑缺血发作以及心血管疾病有关。此外，早期研究表明，TRT 可通过以下方式改善低睾酮水平男性的代谢状况：降低 2 型糖尿病男性的血糖和 HbA1C，减少腹围，改善代谢综合征的特征，所有这些都可能对心血管系统有保护作用。
主要的安全问题是前列腺癌，但没有证据表明睾酮会导致新癌症的发展。因此，总的来说，如果一个有性腺功能减退和低或低睾酮水平的男性有症状，且没有前列腺癌的证据，如正常的 PSA，那么进行 4-6 个月的 TRT 治疗试验是合理的。这种持续时间的治疗和监测将确定患者是否有反应。
