Drewa Tomasz, Olszewska-Słonina Dorota, Chlosta Piotr
Department of Urology, Institute of Oncology, Romanowskiej 2, 85-796 Bydgoszcz, Poland.
Acta Pol Pharm. 2011 Sep-Oct;68(5):623-7.
Controversy surrounds testosterone replacement therapy in obese ageing due to no generally accepted lower limits of normal testosterone level and high prevalence of hypogonadal symptoms in the ageing male population and the non-specific nature of these symptoms. Late onset hypogonadism is a clinical and biochemical syndrome associated with advancing age, often coexisting with obesity and metabolic syndrome. High fat and carbohydrates (fructose) consumption is responsible for development of obesity and metabolic syndrome which is one of risk factors for hypogonadism in older men. High fructose intake has been shown to cause dyslipidemia and to impair hepatic insulin sensitivity. Obesity and lack of physical activity negatively influence testosterone level. Low testosterone level should be regarded as an effect of obesity, but reverse relationship has not been proved yet. The management of late-onset hypogonadism symptoms has to be treated by a change of a life style and prevented with healthy nutrition and physical activity. The question related to rational indications for testosterone replacement therapy in obese males seems to be still actual.
由于目前尚无普遍公认的正常睾酮水平下限，且老年男性人群中性腺功能减退症状的高患病率以及这些症状的非特异性，肥胖老年人的睾酮替代疗法存在争议。迟发性性腺功能减退是一种与年龄增长相关的临床和生化综合征，常与肥胖和代谢综合征并存。高脂肪和碳水化合物（果糖）的摄入是导致肥胖和代谢综合征的原因，而肥胖和代谢综合征是老年男性性腺功能减退的危险因素之一。高果糖摄入已被证明会导致血脂异常并损害肝脏胰岛素敏感性。肥胖和缺乏体育活动会对睾酮水平产生负面影响。低睾酮水平应被视为肥胖的结果，但尚未证实存在相反的关系。迟发性性腺功能减退症状的管理必须通过改变生活方式来治疗，并通过健康的营养和体育活动来预防。肥胖男性睾酮替代疗法的合理适应症问题似乎仍然很实际。
