Grossmann Mathis, Matsumoto Alvin M
Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Victoria 3081, Australia.
Endocrine Unit, Austin Health, Heidelberg, Victoria 3052, Australia.
J Clin Endocrinol Metab. 2017 Mar 1;102(3):1067-1075. doi: 10.1210/jc.2016-3580.
Middle-aged and older men (≥50 years), especially those who are obese and suffer from comorbidities, not uncommonly present with clinical features consistent with androgen deficiency and modestly reduced testosterone levels. Commonly, such men do not demonstrate anatomical hypothalamic-pituitary-testicular axis pathology but have functional hypogonadism that is potentially reversible.
Literature review from 1970 to October 2016.
Although definitive randomized controlled trials are lacking, evidence suggests that in such men, lifestyle measures to achieve weight loss and optimization of comorbidities, including discontinuation of offending medications, lead to clinical improvement and a modest increase in testosterone. Also, androgen deficiency-like symptoms and end-organ deficits respond to targeted treatments (such as phosphodiesterase-5 inhibitors for erectile dysfunction) without evidence that hypogonadal men are refractory. Unfortunately, lifestyle interventions remain difficult and may be insufficient even if successful. Testosterone therapy should be considered primarily for men who have significant clinical features of androgen deficiency and unequivocally low testosterone levels. Testosterone should be initiated either concomitantly with a trial of lifestyle measures, or after such a trial fails, after a tailored diagnostic work-up, exclusion of contraindications, and appropriate counseling.
There is modest evidence that functional hypogonadism responds to lifestyle measures and optimization of comorbidities. If achievable, these interventions may have demonstrable health benefits beyond the potential for increasing testosterone levels. Therefore, treatment of underlying causes of functional hypogonadism and of symptoms should be used either as an initial or adjunctive approach to testosterone therapy.
中老年男性（≥50岁），尤其是肥胖且患有合并症的男性，常表现出与雄激素缺乏相符的临床特征以及睾酮水平适度降低。通常，这类男性并无下丘脑 - 垂体 - 睾丸轴的解剖学病理改变，而是存在潜在可逆的功能性性腺功能减退。
对1970年至2016年10月的文献进行综述。
尽管缺乏确切的随机对照试验，但有证据表明，对于这类男性，通过生活方式干预实现体重减轻和合并症的优化管理，包括停用有害药物，可带来临床改善并使睾酮水平适度升高。此外，类似雄激素缺乏的症状和靶器官功能缺陷对针对性治疗（如用于勃起功能障碍的磷酸二酯酶 - 5抑制剂）有反应，且没有证据表明性腺功能减退男性对此类治疗无效。遗憾的是，生活方式干预仍然困难，即便成功也可能并不充分。睾酮治疗应主要考虑用于有明显雄激素缺乏临床特征且睾酮水平明确降低的男性。睾酮治疗可在进行生活方式干预的同时开始，或在该干预失败后，经过针对性的诊断检查、排除禁忌证并给予适当咨询后开始。
有适度证据表明功能性性腺功能减退对生活方式干预和合并症优化管理有反应。如果可行，这些干预措施可能除了有提高睾酮水平的潜力外，还具有明显的健康益处。因此，治疗功能性性腺功能减退的潜在病因及症状应用作睾酮治疗的初始或辅助方法。
