Cooper Lori A, Page Stephanie T
Department of Medicine, Division of Endocrinology and Metabolism, University of Washington; University of Washington and Harborview Medical Center, Seattle, Washington, USA.
Asian J Androl. 2014 Mar-Apr;16(2):248-55. doi: 10.4103/1008-682X.122361.
A growing body of literature has established the anabolic benefi ts of testosterone (T) therapy in hypogonadal men. However, there remains a paucity of data regarding the risks of exogenous androgen use in older men and the potential for adverse effects on the prostate gland. Whether T therapy in older, hypogonadal men might worsen lower urinary tract symptoms or exacerbate, unmask, or even incite prostate cancer development has tempered enthusiasm for T therapy, while known prostatic disease has served as a relative contraindication to T therapy. Androgens are necessary for the development and maintenance of the prostate gland. However, epidemiologic studies do not consistently fi nd a positive relationship between endogenous serum androgen concentrations and the risk of prostate disease. Recent data demonstrate that 5α-reductase inhibitors decrease the risk of low-grade prostate cancer, suggesting that modifying androgen metabolism may have beneficial effects on prostate health, yet similar reductions in high-grade disease have not been observed, thereby questioning the true clinical benefits of these agents for chemoprevention. Knowing how to best investigate the relationship between androgens and the development of prostate disease given the lack of large, randomized trials is difficult. Accumulating data challenges the assumption that alterations in serum androgens have parallel effects within the prostate hormonal environment or change androgen-regulated processes within the gland. Long-term intervention studies are needed to truly ascertain the effects of androgen manipulation on prostate tissue and disease risk. However, available data do not support the notion that restoring serum androgens to normal physiologic ranges drives prostate disease.
越来越多的文献证实了睾酮（T）治疗对性腺功能减退男性的合成代谢益处。然而，关于老年男性使用外源性雄激素的风险以及对前列腺潜在不良影响的数据仍然匮乏。老年性腺功能减退男性的T治疗是否会加重下尿路症状或加剧、暴露甚至引发前列腺癌的发生，这减弱了人们对T治疗的热情，而已知的前列腺疾病已成为T治疗的相对禁忌证。雄激素对于前列腺的发育和维持是必需的。然而，流行病学研究并未始终发现内源性血清雄激素浓度与前列腺疾病风险之间存在正相关关系。最近的数据表明，5α-还原酶抑制剂可降低低级别前列腺癌的风险，这表明改变雄激素代谢可能对前列腺健康有益，但尚未观察到高级别疾病有类似程度的降低，从而对这些药物在化学预防方面的真正临床益处提出了质疑。鉴于缺乏大型随机试验，要知道如何最好地研究雄激素与前列腺疾病发生之间的关系很困难。越来越多的数据对血清雄激素变化在前列腺激素环境中具有平行效应或改变腺体内雄激素调节过程这一假设提出了挑战。需要进行长期干预研究来真正确定雄激素调控对前列腺组织和疾病风险的影响。然而，现有数据并不支持将血清雄激素恢复到正常生理范围会引发前列腺疾病这一观点。
