Ramasamy Ranjith, Wilken Nathan, Scovell Jason M, Kovac Jason R, Lipshultz Larry I
Department of Urology, Baylor College of Medicine, Houston, TX.
Department of Urology, Baylor College of Medicine, Houston, TX.
Urology. 2014 Dec;84(6):1378-82. doi: 10.1016/j.urology.2014.07.049. Epub 2014 Oct 5.
To determine the association between hypogonadal symptoms and total serum testosterone levels in middle-aged and elderly men (aged > 40 years), and to identify whether there exists a clear-cut discriminatory threshold of total testosterone below which the probability of hypogonadal symptoms increases.
We retrospectively reviewed the charts of 360 men who presented to an outpatient men's health clinic with a chief complaint of low testosterone. Sexual, psychological, and physical symptoms were evaluated using the androgen deficiency in the aging male (ADAM) questionnaire. Serum levels of total testosterone were collected on the same day on which men completed their ADAM questionnaires. We performed the univariate (t test, chi-square, and binary logistic regression) and multivariate analyses (binary logistic regression) to evaluate the total testosterone threshold and the symptoms that predicted a low-testosterone level.
A cluster of symptoms: 1 sexual (decreased libido), 1 psychological (decreased energy), and 3 physical (decreased strength or endurance, decreased ability to play sports, and falling asleep after dinner) were most associated with total serum testosterone levels of ≤ 300 ng/dL. The threshold testosterone serum levels that were associated with an increased prevalence of these hypogonadal symptoms ranged from 320 to 375 ng/dL. On multivariate analysis, age, but not symptoms on the ADAM questionnaire, predicted a total testosterone level of < 300 ng/dL.
A distinct constellation of hypogonadal symptoms exists at various serum testosterone levels. Consequently, identification of the thresholds for specific symptom management will be critical in establishing patient-centered treatment algorithms.
确定中老年男性（年龄>40岁）性腺功能减退症状与血清总睾酮水平之间的关联，并确定总睾酮是否存在明确的区分阈值，低于该阈值性腺功能减退症状的发生概率会增加。
我们回顾性分析了360名因睾酮水平低为主诉前来男性健康门诊就诊的男性病历。使用老年男性雄激素缺乏（ADAM）问卷评估性、心理和身体症状。在男性完成ADAM问卷的同一天采集血清总睾酮水平。我们进行了单变量分析（t检验、卡方检验和二元逻辑回归）和多变量分析（二元逻辑回归），以评估总睾酮阈值和预测低睾酮水平的症状。
一组症状：1个性症状（性欲减退）、1个心理症状（精力下降）和3个身体症状（力量或耐力下降、运动能力下降、饭后入睡）与血清总睾酮水平≤300 ng/dL最为相关。与这些性腺功能减退症状患病率增加相关的睾酮血清阈值范围为320至375 ng/dL。多变量分析显示，年龄而非ADAM问卷上的症状可预测总睾酮水平<300 ng/dL。
在不同的血清睾酮水平下存在明显的性腺功能减退症状群。因此，确定特定症状管理的阈值对于建立以患者为中心的治疗方案至关重要。
