Sections of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts, USA.
J Clin Endocrinol Metab. 2011 Aug;96(8):2430-9. doi: 10.1210/jc.2010-3012. Epub 2011 Jun 22.
Reference ranges are essential for partitioning testosterone levels into low or normal and making the diagnosis of androgen deficiency. We established reference ranges for total testosterone (TT) and free testosterone (FT) in a community-based sample of men.
TT was measured using liquid chromatography tandem mass spectrometry in nonobese healthy men, 19-40 yr old, in the Framingham Heart Study Generation 3; FT was calculated. Values below the 2.5th percentile of reference sample were deemed low. We determined the association of low TT and FT with physical dysfunction, sexual symptoms [European Male Aging Study (EMAS) only], and diabetes mellitus in three cohorts: Framingham Heart Study generations 2 and 3, EMAS, and the Osteoporotic Fractures in Men Study.
In a reference sample of 456 men, mean (sd), median (quartile), and 2.5th percentile values were 723.8 (221.1), 698.7 (296.5), and 348.3 ng/dl for TT and 141. 8 (45.0), 134.0 (60.0), and 70.0 pg/ml for FT, respectively. In all three samples, men with low TT and FT were more likely to have slow walking speed, difficulty climbing stairs, or frailty and diabetes than those with normal levels. In EMAS, men with low TT and FT were more likely to report sexual symptoms than men with normal levels. Men with low TT and FT were more likely to have at least one of the following: sexual symptoms (EMAS only), physical dysfunction, or diabetes.
Reference ranges generated in a community-based sample of men provide a rational basis for categorizing testosterone levels as low or normal. Men with low TT or FT by these criteria had higher prevalence of physical dysfunction, sexual dysfunction, and diabetes. These reference limits should be validated prospectively in relation to incident outcomes and in randomized trials.
参考范围对于将睾酮水平分为低或正常水平并做出雄激素缺乏症的诊断至关重要。我们在一项基于社区的男性样本中建立了总睾酮（TT）和游离睾酮（FT）的参考范围。
在 Framingham 心脏研究第 3 代中，对非肥胖健康的 19-40 岁男性使用液相色谱串联质谱法测量 TT；计算 FT。参考样本中低于第 2.5 百分位数的数值被认为是低的。我们在三个队列中确定了低 TT 和 FT 与身体功能障碍、性症状[仅欧洲男性老龄化研究（EMAS）]和糖尿病的关联：Framingham 心脏研究第 2 代和第 3 代、EMAS 和男性骨质疏松性骨折研究。
在一个 456 名男性的参考样本中，平均（标准差）、中位数（四分位数）和第 2.5 百分位数的 TT 值分别为 723.8（221.1）、698.7（296.5）和 348.3ng/dl，FT 值分别为 141.8（45.0）、134.0（60.0）和 70.0pg/ml。在所有三个样本中，与正常水平相比，低 TT 和 FT 的男性更有可能出现行走速度慢、爬楼梯困难或虚弱和糖尿病等问题。在 EMAS 中，与正常水平相比，低 TT 和 FT 的男性更有可能报告性症状。低 TT 和 FT 的男性更有可能存在以下至少一种情况：性症状（仅 EMAS）、身体功能障碍或糖尿病。
在基于社区的男性样本中生成的参考范围为将睾酮水平归类为低或正常提供了合理的依据。根据这些标准，低 TT 或 FT 的男性更可能出现身体功能障碍、性功能障碍和糖尿病。这些参考限值应在与事件结果和随机试验相关的前瞻性验证。
