The University of Manchester, Manchester Academic Health Science Centre, Department of Endocrinology, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, United Kingdom.
J Clin Endocrinol Metab. 2010 Apr;95(4):1810-8. doi: 10.1210/jc.2009-1796. Epub 2010 Feb 19.
The diagnosis of late-onset hypogonadism (LOH) in older men with age-related declines in testosterone (T) is currently not well characterized.
Our objective was to investigate whether different forms of hypogonadism can be distinguished among aging men.
The study was a cross-sectional survey on 3369 community-dwelling men aged 40-79 yr in eight European centers.
Four groups of subjects were defined: eugonadal (normal T and normal LH), secondary (low T and low/normal LH), primary (low T and elevated LH), and compensated (normal T and elevated LH) hypogonadism. Relationships between the defined gonadal status with potential risk factors and clinical symptoms were investigated by multilevel regression models.
Among the men, 11.8, 2.0, and 9.5% were classified into the secondary, primary, and compensated hypogonadism categories, respectively. Older men were more likely to have primary [relative risk ratio (RRR) = 3.04; P < 0.001] and compensated (RRR = 2.41; P < 0.001) hypogonadism. Body mass index of 30 kg/m(2) or higher was associated with secondary hypogonadism (RRR = 8.74; P < 0.001). Comorbidity was associated with both secondary and primary hypogonadism. Sexual symptoms were more prevalent in secondary and primary hypogonadism, whereas physical symptoms were more likely in compensated hypogonadism.
Symptomatic elderly men considered to have LOH can be differentiated on the basis of endocrine and clinical features and predisposing risk factors. Secondary hypogonadism is associated with obesity and primary hypogonadism predominately with age. Compensated hypogonadism can be considered a distinct clinical state associated with aging. Classification of LOH into different categories by combining LH with T may improve the diagnosis and management of LOH.
目前对于因年龄相关的睾酮（T）下降而出现的迟发性性腺功能减退症（LOH）的老年男性患者，其诊断尚无法明确。
本研究旨在探讨衰老男性中是否存在不同形式的性腺功能减退症。
这是一项在欧洲 8 个中心的 3369 名年龄在 40-79 岁的社区男性中进行的横断面调查。
将研究对象分为 4 组：正常性腺功能（正常 T 和正常 LH）、继发性（低 T 和低/正常 LH）、原发性（低 T 和升高 LH）和补偿性（正常 T 和升高 LH）性腺功能减退症。采用多层次回归模型探讨定义的性腺状态与潜在的危险因素和临床症状之间的关系。
在这些男性中，11.8%、2.0%和 9.5%分别被归类为继发性、原发性和补偿性性腺功能减退症。年龄较大的男性更有可能出现原发性（相对风险比[RRR] = 3.04；P < 0.001）和补偿性（RRR = 2.41；P < 0.001）性腺功能减退症。体重指数（BMI）为 30 kg/m(2)或更高与继发性性腺功能减退症相关（RRR = 8.74；P < 0.001）。合并症与继发性和原发性性腺功能减退症均相关。继发性和原发性性腺功能减退症患者更易出现性功能障碍症状，而补偿性性腺功能减退症患者更易出现躯体症状。
根据内分泌和临床特征以及潜在的危险因素，可对有症状的老年男性患者进行 LOH 区分。继发性性腺功能减退症与肥胖有关，而原发性性腺功能减退症则主要与年龄有关。补偿性性腺功能减退症可被认为是一种与衰老相关的独特临床状态。通过结合 LH 和 T 将 LOH 分类为不同类别，可能会改善 LOH 的诊断和管理。
