游离睾酮水平低与总睾酮正常男性的低促性腺激素性性腺功能减退症体征和症状有关。
Low Free Testosterone Is Associated with Hypogonadal Signs and Symptoms in Men with Normal Total Testosterone.
机构信息
Department of Clinical and Experimental Medicine (L.A., B.D., D.V.), KU Leuven, Laboratory of Clinical and Experimental Endocrinology, Leuven, Belgium; Department of Cellular and Molecular Medicine (L.A., M.R.L., F.C.), KU Leuven, Laboratory of Molecular Endocrinology, Leuven, Belgium; Department of Endocrinology (L.A., B.D., D.V.), University Hospitals Leuven, Leuven, Belgium; Andrology Research Unit (F.C.W.W., T.B.A.), Endocrinology and Diabetes Research Group, Institute of Human Development, Faculty of Medical and Human Sciences, The University of Manchester, Manchester, UK; Manchester Royal Infirmary (F.C.W.W.), Central Manchester University Hospitals National Health Services (NHS) Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Arthritis Research UK Centre of Epidemiology (T.W.O.N., S.R.P.), The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit (T.W.O.N.), Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Department of Clinical and Experimental Medicine (M.R.L.), KU Leuven, Laboratory of Gerontology and Geriatrics, Leuven, Belgium; Department of Surgery and Cancer, Imperial College London (I.T.H.), Hammersmith Campus, London, UK; Department of Physiology (I.T.H.), Institute of Biomedicine, University of Turku, Turku, Finland; Department of Human Nutrition (M.E.J.L.), University of Glasgow, Glasgow, UK; Department of Clinical Biochemistry (B.G.K.), University Hospital of South Manchester, Manchester, UK; Sexual Medicine and Andrology Unit (G.R.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Endocrinology Unit (G.F.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Department of Obstetrics, Gynaecology and Andrology (G.B.), Albert Szent-György Medica
出版信息
J Clin Endocrinol Metab. 2016 Jul;101(7):2647-57. doi: 10.1210/jc.2015-4106. Epub 2016 Feb 24.
CONTEXT
During aging, total testosterone (TT) declines and SHBG increases, resulting in a greater decrease in calculated free T (cFT). Currently, guidelines suggest using TT to diagnose androgen deficiency and to reserve cFT only for men with borderline TT.
OBJECTIVE
Our objective was to investigate if either low cFT or low TT is more strongly associated with androgen-related clinical endpoints.
METHODS
A total of 3334 community-dwelling men, aged 40-79 years, were included in this study. Differences in clinical variables between the referent group of men with both normal TT (≥10.5 nmol/liter) and normal cFT (≥220 pmol/liter) with those who had normal TT/low cFT, low TT/normal cFT, and low TT/low cFT were assessed by regression models adjusted for age, center, body mass index, and comorbidities.
RESULTS
A total of 2641 men had normal TT (18.4 ± 5.5 [mean ± SD] nmol/liter)/normal cFT (326 ± 74 pmol/liter), 277 men had normal TT (14.2 ± 3.7)/low cFT (194 ± 23), 96 men had low TT (9.6 ± 0.7)/normal cFT (247 ± 20), and 320 men had low TT (7.8 ± 2.5)/low cFT (160 ± 55). Men with normal TT/low cFT were older and in poorer health. They had higher SHBG and LH and reported more sexual and physical symptoms, whereas hemoglobin and bone ultrasound parameters were lower compared to the referent group. Men with low TT/normal cFT were younger and more obese. They had lower SHBG, but LH was normal, whereas features of androgen deficiency were lacking.
CONCLUSIONS
Low cFT, even in the presence of normal TT, is associated with androgen deficiency-related symptoms. Normal cFT, despite low TT, is not associated with cognate symptoms; therefore, cFT levels should be assessed in men with suspected hypogonadal symptoms.
背景
随着年龄的增长，总睾酮（TT）下降，性激素结合球蛋白（SHBG）增加，导致计算得出的游离睾酮（cFT）下降更大。目前，指南建议使用 TT 来诊断雄激素缺乏症，并仅将 cFT 保留用于 TT 处于边缘值的男性。
目的
我们的目的是研究低 cFT 或低 TT 是否与雄激素相关的临床终点更密切相关。
方法
共纳入 3334 名年龄在 40-79 岁之间的社区居住男性。通过回归模型评估 TT 和 cFT 均正常（TT≥10.5 nmol/L，cFT≥220 pmol/L）的男性与 TT 正常/cFT 降低、TT 降低/cFT 正常、TT 降低/cFT 降低这三组参考组之间的临床变量差异，回归模型调整了年龄、中心、体重指数和合并症。
结果
2641 名男性 TT 正常（18.4±5.5 [均值±标准差] nmol/L）/cFT 正常（326±74 pmol/L），277 名男性 TT 正常（14.2±3.7）/cFT 降低（194±23），96 名男性 TT 降低（9.6±0.7）/cFT 正常（247±20），320 名男性 TT 降低（7.8±2.5）/cFT 降低（160±55）。TT 正常/cFT 降低的男性年龄较大，健康状况较差。他们的 SHBG 和 LH 较高，报告的性和身体症状较多，而血红蛋白和骨超声参数较低。TT 降低/cFT 正常的男性较年轻，更肥胖。他们的 SHBG 较低，但 LH 正常，缺乏雄激素缺乏的特征。
结论
即使 TT 正常，cFT 降低也与雄激素缺乏相关的症状有关。尽管 TT 降低，但 cFT 正常并不与相关症状有关；因此，对于有疑似性腺功能减退症状的男性，应评估 cFT 水平。
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