Department of Endocrinology, VU University Medical Center, Amsterdam, the Netherlands.
Asian J Androl. 2010 Mar;12(2):136-51. doi: 10.1038/aja.2010.4. Epub 2010 Feb 15.
Many signs of aging, such as sexual dysfunction, visceral obesity, impaired bone and muscle strength, bear a close resemblance to features of hypogonadism in younger men. The statistical decline of serum testosterone in aging men is solidly documented. It has been presumed that the above features of aging are related to the concurrent decline of androgens, and that correction of the lower-than-normal circulating levels of testosterone will lead to improvement of symptoms of aging. But in essence, the pivotal question whether the age-related decline of testosterone must be viewed as hypogonadism, in the best case reversed by testosterone treatment, has not been definitively resolved. Studies in elderly men with lower-than-normal testosterone report improvement of features of the metabolic syndrome, bone mineral density, of mood and of sexual functioning. But as yet there is no definitive proof of the beneficial effects of restoring testosterone levels to normal in elderly men on clinical parameters. Few of these studies meet as yet rigorous standards of scientific enquiry: double-blind, placebo-controlled design of the study. The above applies also to the assessment of safety of testosterone administration to elderly men. There is so far no convincing evidence that testosterone is a main factor in the development of prostate cancer in elderly men and guidelines for monitoring the development of prostate disease have been developed. It is of note that there are presently no long-term safety data with regard to the prostate. Polycythemia is another potential complication of testosterone treatment. It is dose dependent and can be managed with dose adjustment.
许多衰老的迹象，如性功能障碍、内脏肥胖、骨量和肌肉力量下降，与年轻男性的性腺功能减退症特征非常相似。男性血清睾酮水平随年龄下降的统计数据得到了充分证实。人们推测，衰老的上述特征与雄激素的同时下降有关，纠正低于正常循环水平的睾酮将导致衰老症状的改善。但实际上，关于与年龄相关的睾酮下降是否必须被视为性腺功能减退症，在最好的情况下是否可以通过睾酮治疗逆转，这个关键问题尚未得到明确解决。对睾酮水平低于正常的老年男性进行的研究报告称，代谢综合征、骨密度、情绪和性功能的特征得到了改善。但迄今为止，尚无确凿证据表明将老年男性的睾酮水平恢复正常会对临床参数产生有益影响。这些研究中很少有符合严格科学研究标准的：研究设计为双盲、安慰剂对照。上述情况也适用于评估睾酮对老年男性的安全性。目前尚无令人信服的证据表明睾酮是老年男性前列腺癌发展的主要因素，已经制定了监测前列腺疾病发展的指南。值得注意的是，目前还没有关于前列腺的长期安全性数据。红细胞增多症是睾酮治疗的另一种潜在并发症。它与剂量有关，可以通过调整剂量来控制。
