Gulhane School of Medicine, Department of Endocrinology, Ankara, Turkey.
Horm Metab Res. 2013 Jun;45(6):443-8. doi: 10.1055/s-0033-1343447. Epub 2013 Apr 23.
Metabolic disorders and cardiovascular events are increased in hypogonadism. Serum HDL composition is a better cardiovascular predictor than the HDL counts. However, there is no information about the HDL subfractions in patients with hypogonadism. We designed a prospective study to investigate the HDL subfractions in treatment naïve subjects with hypogonadism and the effects of 2 different testosterone replacement regimens on the HDL subfractions. Seventy young male patients with congenital hypogonadotropic hypogonadism (CHH) and 70 age and BMI-matched healthy males were enrolled in the present study. The patients were assigned to receive intramuscular injections of testosterone esters 250 mg every 3 weeks and transdermal testosterone applications 50 mg daily. Biochemical investigations including HDL subfractions and insulin resistance were done. Patients with CHH had higher levels of insulin, HOMA-IR, WC, triglyceride, and diastolic blood pressure. Although, the HDL cholesterol concentrations were similar in both groups, hypogonadal patients had lower HDL2 and higher HDL3 levels. The total testosterone levels were independent determinants of the HDL2 subfractions. During the follow-up, a significant increase in the BMI and WC values and a significant decrease in the levels of total cholesterol, HDL cholesterol, and HDL3 were observed. No difference was present between the 2 treatment arms. These results show that patients with hypogonadism have unfavorable HDL compositions in addition to the other dysmetabolic features. However, testosterone replacement for about six months neither improves the metabolic problems nor the HDL composition. Mechanistic studies are warranted to better understand the cardiovascular effects of unfavorable HDL compositions in hypogonadism.
代谢紊乱和心血管事件在性腺功能减退症中增加。血清高密度脂蛋白（HDL）组成是心血管疾病的更好预测指标，优于 HDL 计数。然而，关于性腺功能减退症患者的 HDL 亚组分尚无信息。我们设计了一项前瞻性研究，以调查治疗初治性腺功能减退症患者的 HDL 亚组分，以及两种不同的睾酮替代疗法对 HDL 亚组分的影响。本研究纳入了 70 例先天性促性腺激素缺乏性性腺功能减退症（CHH）年轻男性患者和 70 例年龄和 BMI 匹配的健康男性。患者被分配接受肌肉注射睾酮酯 250mg，每 3 周一次，和经皮应用睾酮 50mg，每天一次。进行了生化检查，包括 HDL 亚组分和胰岛素抵抗。CHH 患者的胰岛素、HOMA-IR、WC、甘油三酯和舒张压水平较高。尽管两组的 HDL 胆固醇浓度相似，但性腺功能减退症患者的 HDL2 较低，HDL3 较高。总睾酮水平是 HDL2 亚组分的独立决定因素。在随访期间，观察到 BMI 和 WC 值显著增加，总胆固醇、HDL 胆固醇和 HDL3 水平显著降低。两种治疗方案之间没有差异。这些结果表明，性腺功能减退症患者除了其他代谢紊乱特征外，还具有不利的 HDL 组成。然而，大约 6 个月的睾酮替代治疗既不能改善代谢问题，也不能改善 HDL 组成。需要进行机制研究，以更好地了解性腺功能减退症中不利的 HDL 组成对心血管的影响。
