Huang Grace, Travison Thomas, Maggio Marcello, Edwards Robert R, Basaria Shehzad
The Research Program in Men's Health: Aging and Metabolism, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Institute for Aging Research, Hebrew Senior Life, Boston, MA, USA.
Clin Endocrinol (Oxf). 2016 Aug;85(2):232-8. doi: 10.1111/cen.13049. Epub 2016 Apr 4.
Symptomatic androgen deficiency is common in patients taking opioid analgesics, and testosterone replacement in these men improves libido, quality of life and body composition. However, the effects of testosterone replacement on metabolic and inflammatory markers in this setting have not been evaluated. This is important as opiate use itself has been associated with metabolic abnormalities. The objective of this investigation was to determine the effects of testosterone administration on metabolic and inflammatory markers in adult men with opioid-induced androgen deficiency.
Sixty-four nondiabetic men aged 18 to 64 years using opioid analgesics for chronic noncancer pain with total testosterone levels <12 nmol/l were randomized to 14 weeks of transdermal testosterone gel or placebo gel daily. Total testosterone levels were measured by liquid chromatography mass spectrometry, and free testosterone was calculated using the law-of-mass-action equation. Metabolic parameters, inflammatory markers and oral glucose tolerance test (OGTT) were evaluated at baseline and 14 weeks.
Baseline characteristics were similar between the two groups. Testosterone concentrations increased from 7·7 ± 3·0 to 27 ± 19 nmol/l in the testosterone group, but did not meaningfully change in placebo group. Mean changes in metabolic and inflammatory markers during intervention did not differ significantly between groups and were not related to changes in on-treatment serum testosterone concentrations. Glucose and insulin response to the 75 g OGTT also did not differ between groups.
In this 14-week trial, testosterone administration in men with opioid-induced androgen deficiency was not associated with worsening of metabolic and inflammatory markers.
有症状的雄激素缺乏在服用阿片类镇痛药的患者中很常见，对这些男性进行睾酮替代治疗可改善性欲、生活质量和身体成分。然而，在这种情况下，睾酮替代治疗对代谢和炎症标志物的影响尚未得到评估。这一点很重要，因为阿片类药物的使用本身就与代谢异常有关。本研究的目的是确定给予睾酮对患有阿片类药物引起的雄激素缺乏的成年男性的代谢和炎症标志物的影响。
64名年龄在18至64岁之间、因慢性非癌性疼痛使用阿片类镇痛药且总睾酮水平<12 nmol/l的非糖尿病男性被随机分为两组，分别每日使用经皮睾酮凝胶或安慰剂凝胶，为期14周。通过液相色谱质谱法测量总睾酮水平，并使用质量作用定律方程计算游离睾酮。在基线和14周时评估代谢参数、炎症标志物和口服葡萄糖耐量试验（OGTT）。
两组的基线特征相似。睾酮组的睾酮浓度从7·7±3·0 nmol/l增加到27±19 nmol/l，而安慰剂组没有明显变化。干预期间两组代谢和炎症标志物的平均变化没有显著差异，且与治疗期间血清睾酮浓度的变化无关。两组对75 g OGTT的葡萄糖和胰岛素反应也没有差异。
在这项为期14周的试验中，对患有阿片类药物引起的雄激素缺乏的男性给予睾酮治疗与代谢和炎症标志物的恶化无关。
