Division of Endocrinology, State University of New York at Buffalo and Kaleida Health, Buffalo, New York 14209, USA.
J Clin Endocrinol Metab. 2011 Sep;96(9):2643-51. doi: 10.1210/jc.2010-2724.
Studies over the last few years have clearly established that at least 25% of men with type 2 diabetes have subnormal free testosterone concentrations in association with inappropriately low LH and FSH concentrations. Another 4% have subnormal testosterone concentrations with elevated LH and FSH concentrations. The Endocrine Society, therefore, now recommends the measurement of testosterone in patients with type 2 diabetes on a routine basis. The subnormal testosterone concentrations are not related to glycosylated hemoglobin or duration of diabetes, but are associated with obesity, very high C-reactive protein concentrations, and mild anemia. In addition, subnormal testosterone concentrations in these men are associated with a two to three times elevated risk of cardiovascular events and death in two early studies. Short-term studies of testosterone therapy in hypogonadal men with type 2 diabetes have demonstrated an increase in insulin sensitivity and a decrease in waist circumference. However, the data on the effect of testosterone replacement on glycemic control and cardiovascular risk factors such as cholesterol and C-reactive protein concentrations are inconsistent. As far as sexual function is concerned, testosterone treatment increases libido but does not improve erectile dysfunction and thus, phosphodiesterase inhibitors may be required. Trials of a longer duration are clearly required to definitively establish the benefits and risks of testosterone replacement in patients with type 2 diabetes and low testosterone.
过去几年的研究清楚地表明，至少有 25%的 2 型糖尿病男性伴有 LH 和 FSH 浓度过低的异常低游离睾酮浓度。另有 4%的男性的睾酮浓度异常低，同时 LH 和 FSH 浓度升高。因此，内分泌学会现在建议常规测量 2 型糖尿病患者的睾酮水平。睾酮浓度降低与糖化血红蛋白或糖尿病持续时间无关，但与肥胖、高 C 反应蛋白浓度和轻度贫血有关。此外，在两项早期研究中，这些男性的睾酮浓度降低与心血管事件和死亡风险增加 2-3 倍有关。对 2 型糖尿病伴性腺功能减退男性进行的短期睾酮治疗研究表明，胰岛素敏感性增加，腰围减少。然而，关于睾酮替代治疗对血糖控制和胆固醇和 C 反应蛋白浓度等心血管危险因素的影响的数据并不一致。就性功能而言，睾酮治疗可提高性欲，但不能改善勃起功能障碍，因此可能需要使用磷酸二酯酶抑制剂。显然需要进行更长时间的试验，以明确确定 2 型糖尿病和低睾酮患者使用睾酮替代治疗的益处和风险。
