Yafi Faysal A, Haney Nora M, Anaissie James, DeLay Kenneth J, Trost Landon, Khera Mohit, Hellstrom Wayne J G
Department of Urology, University of California, Irvine, CA.
Department of Urology, Tulane University School of Medicine, New Orleans, LA.
Urology. 2017 Aug;106:87-95. doi: 10.1016/j.urology.2017.04.036. Epub 2017 May 4.
To describe practice patterns in the diagnosis and treatment of hypogonadism, as the optimal approaches are controversial. Multiple therapeutic options are currently available for hypogonadal men and treatment patterns vary considerably. The safety of testosterone therapy (TTh) remains understudied.
A 23-question survey regarding diagnosis and treatment of hypogonadism was sent to all members of the Sexual Medicine Society of North America. Subgroup analyses compared responses between sexual medicine fellows and non-fellows, as well as between academic and nonacademic physicians, using a chi-squared analysis.
A total of 101 responses were included for analysis. The most common cutoff value used to diagnose hypogonadism was 300 ng/dL (55%, range = 200-400 ng/dL), and 31% felt comfortable giving TTh to a symptomatic patient with normal serum testosterone levels. No respondents felt that TTh increased a cardiovascular event risk. Of those surveyed, 68% would prescribe TTh to a hypogonadal man with severe lower urinary tract symptoms, and 64% would offer TTh to a man with low-risk prostate cancer on active surveillance. Fellowship-trained physicians were more likely to prescribe TTh to a man with hypogonadism but normal serum testosterone (P = .038), but they differed in the types of therapy they would use for men with hypogonadism who wish to preserve or regain fertility.
Significant variety exists in the diagnosis and treatment of hypogonadism. The majority of physicians will only prescribe TTh in the setting of subnormal serum testosterone levels, despite the presence of symptoms. None of the surveyed physicians reported concern over the risk of cardiovascular events.
鉴于性腺功能减退的最佳诊断和治疗方法存在争议，描述其诊断和治疗的实践模式。目前性腺功能减退男性有多种治疗选择，治疗模式差异很大。睾酮治疗（TTh）的安全性仍研究不足。
向北美洲性医学协会的所有成员发送了一份关于性腺功能减退诊断和治疗的23个问题的调查问卷。使用卡方分析进行亚组分析，比较性医学研究员与非研究员以及学术医生与非学术医生之间的回答。
共纳入101份回复进行分析。诊断性腺功能减退最常用的临界值是300 ng/dL（55%，范围 = 200 - 400 ng/dL），31%的人对给血清睾酮水平正常但有症状的患者进行TTh治疗感到放心。没有受访者认为TTh会增加心血管事件风险。在接受调查的人中，68%会给有严重下尿路症状的性腺功能减退男性开TTh，64%会给接受主动监测的低风险前列腺癌男性提供TTh。接受过研究员培训的医生更有可能给血清睾酮正常的性腺功能减退男性开TTh（P = 0.038），但在为希望保留或恢复生育能力的性腺功能减退男性选择治疗方法上存在差异。
性腺功能减退的诊断和治疗存在显著差异。大多数医生仅在血清睾酮水平低于正常时才会开TTh，尽管存在症状。接受调查的医生均未报告担心心血管事件风险。
