Nigro Nicole, Christ-Crain Mirjam, Meier Christian
Klinik für Endokrinologie, Diabetologie und Metabolismus, Universitätsspital Basel.
Ther Umsch. 2014 Apr;71(4):229-37. doi: 10.1024/0040-5930/a000506.
The definition of late onset hypogonadism in the aging male is controversially debated, and according to the latest literature consists of at least three especially sexual symptoms such as loss of morning erection, low sexual desire and erectile dysfunction as well as a total testosterone < 8 - 11 nmol/l. Testosterone replacement therapy in the aging male has been shown to have a beneficial effect on muscle and fat mass as well as on bone mineral density, with more conflicting effects observed on muscle strength, sexual function, mood and quality of life. The prescriptions for testosterone products for the indication of the aging male were increased over 170 % in the previous 5 years. Furthermore, there are many epidemiological data showing an inverse relationship between testosterone levels and obesity, insulin resistance, the metabolic syndrome and type 2 diabetes mellitus. However, only few small randomized placebo-controlled studies have investigated the effect of testosterone replacement therapy on insulin resistance and HbA1c levels, with controversial results. Importantly, so far the long-term safety and efficacy of testosterone replacement therapy has not been established. Although until now no clear evidence was found that testosterone replacement therapy has a causative role in prostate cancer or indeed changes the biology of the prostate, in a recent meta-analysis a 4-fold increased risk of prostate-associated event rates in testosterone treated elderly men sounds a note of caution. Also the risk for cardiovascular events is still not clear and caution is warranted especially in elderly men with cardiovascular disease and limited mobility. In summary, the actual available evidence of long-term risks and outcome of testosterone replacement therapy is still very limited and carefully designed placebo-controlled trials of testosterone administration to assess the risks and benefits of such a therapy are required. Until then, testosterone treatment in elderly men should be restricted to elderly men with clearly low testosterone levels in the presence of clinical symptoms and advantages and disadvantages need to be accurately weighted. A careful monitoring of potential side effects is necessary.
老年男性迟发性性腺功能减退的定义存在争议，根据最新文献，其至少包括三种特别是性方面的症状，如晨勃丧失、性欲低下和勃起功能障碍，以及总睾酮水平<8 - 11 nmol/l。老年男性的睾酮替代疗法已被证明对肌肉和脂肪量以及骨密度有有益影响，但在肌肉力量、性功能、情绪和生活质量方面观察到的影响更具争议性。在过去5年中，用于老年男性适应症的睾酮产品处方增加了170%以上。此外，有许多流行病学数据显示睾酮水平与肥胖、胰岛素抵抗、代谢综合征和2型糖尿病之间存在负相关关系。然而，只有少数小型随机安慰剂对照研究调查了睾酮替代疗法对胰岛素抵抗和糖化血红蛋白水平的影响，结果存在争议。重要的是，到目前为止，睾酮替代疗法的长期安全性和有效性尚未确立。尽管到目前为止尚未发现明确证据表明睾酮替代疗法在前列腺癌中具有致病作用或确实改变前列腺生物学，但在最近的一项荟萃分析中，接受睾酮治疗的老年男性前列腺相关事件发生率增加4倍，这敲响了警钟。心血管事件的风险也仍不明确，特别是对于患有心血管疾病和行动不便的老年男性，需要谨慎对待。总之，关于睾酮替代疗法长期风险和结果的实际现有证据仍然非常有限，需要精心设计的安慰剂对照试验来评估这种疗法的风险和益处。在此之前，老年男性的睾酮治疗应仅限于临床症状明显且睾酮水平明显较低的老年男性，并且需要准确权衡利弊。仔细监测潜在副作用是必要的。
