Department of Surgery, University of the West Indies, Mona, Jamaica.
Andrology. 2013 Jul;1(4):576-82. doi: 10.1111/j.2047-2927.2013.00084.x. Epub 2013 Apr 18.
Hypogonadism, which is highly prevalent in men with sickle cell disease (SCD), affects quality of life and causes great morbidity. The safety of testosterone replacement therapy (TRT) in SCD in relation to priapism episodes is relatively unknown. Our aim was to monitor the safety of TRT in a cohort of seven hypogonadal men with SCD. Testosterone undecanoate (Nebido) 1 g was administered intramuscularly to adult men with homozygous SCD (Hb SS) having hypogonadism [serum total testosterone ≤12.0 nmol/L (346 ng/dL), reference range 12.5-38.1 nmol/L (360-1098 ng/dL)] for 12 months. Serum total testosterone, haemoglobin, haematocrit, renal and liver function tests, glucose and PSA measurements were done at baseline and 12-month follow-up. Trough serum total testosterone, haemoglobin and haematocrit were measured three monthly. Priapism events and adverse drug events were assessed every 3 months. International Index of Erectile Function (IIEF), Androgen Deficiency in the Ageing Male (ADAM) and World Health Organization Quality of Life (WHOQOL) questionnaires were administered at baseline, 6 and 12 months. Seven men with a mean age of 34.4 years were treated. Median total testosterone increased from 10.6 to 11.2 nmol/L (p = 0.46). Median serum lactate dehydrogenase levels decreased from 1445 to 1143.5 IU/L (p < 0.05), while all other laboratory indices remained stable. Injection site pain was the most frequently reported adverse event, with no increases in painful crises, hypersensitivity or oedema. After TRT, there was no significant increase in priapism frequency. Median questionnaire scores were increased for the IIEF (46-68, p = 0.018), reduced for ADAM (5.0-2.0, p = 0.016) and unchanged for WHOQOL (98-103, p = 0.086). TRT using testosterone undecanoate with eugonadal intent for hypogonadism appears to be safe in men with SCD. This treatment does not appear to promote priapism occurrences and rather it possibly improves sexual function. Future prospective evaluations in larger groups of hypogonadal men with SCD are necessary to confirm these findings.
患有镰状细胞病（SCD）的男性中，性腺功能减退症的患病率非常高，它会影响生活质量并导致严重的发病率。睾丸激素替代疗法（TRT）在 SCD 中与阴茎异常勃起发作的安全性相对未知。我们的目的是监测 7 名患有 SCD 的性腺功能减退症男性接受睾丸激素十一酸酯（Nebido）1g 肌内注射治疗的安全性。接受治疗的对象为患有纯合子 SCD（Hb SS）的成年男性，其患有性腺功能减退症[血清总睾酮≤12.0 nmol/L（346ng/dL），参考范围 12.5-38.1 nmol/L（360-1098ng/dL）]，治疗时间为 12 个月。在基线和 12 个月随访时进行血清总睾酮、血红蛋白、血细胞比容、肝肾功能、血糖和 PSA 测量。每 3 个月测量一次血清总睾酮和血红蛋白、血细胞比容。每 3 个月评估一次阴茎异常勃起事件和药物不良反应。在基线、6 个月和 12 个月时进行国际勃起功能指数（IIEF）、男性雄激素缺乏症（ADAM）和世界卫生组织生活质量（WHOQOL）问卷评估。7 名男性的平均年龄为 34.4 岁。中位总睾酮从 10.6 增加到 11.2 nmol/L（p=0.46）。中位血清乳酸脱氢酶水平从 1445 降低到 1143.5 IU/L（p＜0.05），而所有其他实验室指标保持稳定。注射部位疼痛是最常报告的不良反应，无疼痛危象、过敏或水肿增加。TRT 后，阴茎异常勃起的频率没有显著增加。IIEF 的中位数评分增加（46-68，p=0.018），ADAM 的评分降低（5.0-2.0，p=0.016），WHOQOL 的评分不变（98-103，p=0.086）。使用睾丸激素十一酸酯进行有生育能力的性腺功能减退症治疗似乎在患有 SCD 的男性中是安全的。这种治疗似乎不会促进阴茎异常勃起的发生，而是可能改善性功能。需要在更大的 SCD 性腺功能减退症男性群体中进行未来的前瞻性评估，以证实这些发现。
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