Miriam Hospital Men's Health Center, Warren Alpert School of Medicine, Brown University, Providence, RI 02906, USA.
Postgrad Med. 2011 May;123(3):17-27. doi: 10.3810/pgm.2011.05.2280.
Testosterone deficiency (TD) is prevalent among men seeking medical attention and may be associated with other comorbidities.
The Testim(®) Registry in the United States (TRiUS), a large, multicenter, prospective, 12-month observational cohort registry, was established to quantify symptoms and comorbidities of hypogonadal men in real-world clinical settings and to evaluate the effect of testosterone replacement therapy (TRT).
Eligible TRiUS participants were hypogonadal men prescribed Testim(®) (1% testosterone gel) for the first time. Evaluated baseline parameters included: total testosterone (TT), free testosterone (FT), sex hormone-binding globulin (SHBG), prostate-specific antigen (PSA), anthropometrics (height, weight, waist, hip, and body mass index [BMI]), lipids, blood glucose, sexual dysfunction, mood/depression, and cardiovascular and metabolic risk factors. Parameters were correlated to TT and age using bivariate correlation and to the combination of TT and age using multiple linear regression.
TRiUS had 849 registrants (baseline TT: 286.5 ± 151.8 ng/dL; FT: 40.8 ± 62.1 pg/mL; SHBG: 28.2 ± 15.0 nmol/L; PSA: 1.12 ± 1.11 ng/mL). Eighty-six percent were overweight/obese, with a BMI ≥ 25 kg/m(2), and 57% were aged 40 to 59 years, with a mean (± standard deviation) age of 52.1 ± 12.3 years. Total testosterone levels were significantly lower in men aged ≥ 65 years. The most common comorbid conditions and cardiovascular risk factors included: smoking, metabolic syndrome, hypertension, dyslipidemia, and coronary artery disease. Weak but statistically significant inverse correlations were noted between TT and sexual dysfunction, fasting glucose, systolic blood pressure, BMI, and Framingham risk scores. Patients with obesity or metabolic syndrome had significantly lower TT levels, particularly among younger and middle-aged patients.
Untreated hypogonadal middle-aged men exhibited a high prevalence of cardiometabolic risk factors that were correlated to TT levels. This suggests that TD is associated with adverse medical conditions that pose serious health risks, especially in a younger age demographic than previously thought. Clinicians may want to consider TT testing in unhealthy, middle-aged patients with symptoms of TD.
寻求医疗关注的男性中普遍存在睾丸激素缺乏症(TD),并且可能与其他合并症有关。
Testim(®)在美国的注册研究(TRiUS)是一个大型的、多中心的、前瞻性的、为期 12 个月的观察队列注册研究,旨在量化现实临床环境中低睾丸激素男性的症状和合并症,并评估睾丸激素替代治疗(TRT)的效果。
合格的 TRiUS 参与者是首次被处方使用 Testim(®)(1%睾丸激素凝胶)的低睾丸激素男性。评估的基线参数包括:总睾酮(TT)、游离睾酮(FT)、性激素结合球蛋白(SHBG)、前列腺特异性抗原(PSA)、人体测量学(身高、体重、腰围、臀围和体重指数[BMI])、血脂、血糖、性功能障碍、情绪/抑郁以及心血管和代谢危险因素。使用双变量相关性分析 TT 和年龄之间的关系,使用多元线性回归分析 TT 和年龄的组合。
TRiUS 有 849 名登记者(基线 TT:286.5±151.8ng/dL;FT:40.8±62.1pg/mL;SHBG:28.2±15.0nmol/L;PSA:1.12±1.11ng/mL)。86%的人超重/肥胖,BMI≥25kg/m(2),57%的人年龄在 40 至 59 岁之间,平均(±标准差)年龄为 52.1±12.3 岁。年龄≥65 岁的男性 TT 水平明显较低。最常见的合并症和心血管危险因素包括:吸烟、代谢综合征、高血压、血脂异常和冠心病。TT 与性功能障碍、空腹血糖、收缩压、BMI 和弗雷明汉风险评分呈弱但有统计学意义的负相关。肥胖或代谢综合征患者的 TT 水平明显较低,尤其是在年轻和中年患者中。
未经治疗的中年低睾丸激素男性表现出高心血管代谢危险因素的患病率,这些危险因素与 TT 水平相关。这表明 TD 与不良的医疗状况有关,这些状况带来严重的健康风险,尤其是在比以前认为的更年轻的年龄组中。临床医生可能希望考虑对有 TD 症状的不健康中年患者进行 TT 检测。