睾酮替代疗法治疗性功能障碍。
Testosterone Replacement Therapy for Sexual Symptoms.
机构信息
Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy.
Pituitary Unit, IRCCS Institute of Neurological Science of Bologna, Bologna, Italy; Endocrinology Unit, Medical Department, Azienda Usl, Maggiore-Bellaria Hospital, Bologna, Italy.
出版信息
Sex Med Rev. 2019 Jul;7(3):464-475. doi: 10.1016/j.sxmr.2018.11.005. Epub 2019 Feb 22.
BACKGROUND
Several data have clearly shown that the endocrine system-and androgens in particular-play a pivotal role in regulating all the steps involved in the male sexual response cycle. Accordingly, testosterone (T) replacement therapy (TRT) represents a cornerstone of pharmacologic management of hypogonadal subjects with erectile dysfunction.
AIM
The aim of this review is to summarize all the available evidence supporting the role of T in the regulation of male sexual function and to provide a comprehensive summary regarding the sexual outcomes of TRT in patients complaining of sexual dysfunction.
METHODS
A comprehensive PubMed literature search was performed.
MAIN OUTCOME MEASURE
Specific analysis of preclinical and clinical evidence on the role of T in regulating male sexual function was performed. In addition, available evidence supporting the role of TRT on several sexual outcomes was separately investigated.
RESULTS
T represents an important modulator of male sexual response function. However, the role of T in sexual functioning is less evident in epidemiologic studies because other factors, including organic, relational, and intrapsychic determinants, can orchestrate their effect independently from the state of androgens. Nonetheless, it is clear that TRT can ameliorate several aspects of sexual functioning, including libido, erectile function, and overall sexual satisfaction. Conversely, data on the role of TRT in improving orgasmic function are more conflicting. Finally, further controlled studies are needed to investigate the combination of TRT and PDE5 inhibitors.
CONCLUSION
Positive effects of TRT are observed only in the presence of a hypogonadal status (ie, total T < 12 nmol/L). In addition, TRT alone can be effective in restoring only milder forms of erectile dysfunction, whereas the combined therapy with other drugs is required when more severe vascular damage is present. Rastrelli G, Guaraldi F, Reismann Y, et al. Testosterone Replacement Therapy for Sexual Symptoms. Sex Med Rev 2019;7:464-475.
背景
多项数据清楚地表明，内分泌系统——尤其是雄激素——在调节男性性反应周期的所有环节中发挥着关键作用。因此，睾酮（T）替代疗法（TRT）是治疗勃起功能障碍的性腺功能减退症患者的药物治疗基石。
目的
本综述旨在总结所有支持 T 调节男性性功能的作用的证据，并提供关于有性功能障碍的患者接受 TRT 的性结果的综合总结。
方法
进行了全面的 PubMed 文献检索。
主要观察指标
对 T 调节男性性功能的作用的临床前和临床证据进行了具体分析。此外，还分别调查了支持 TRT 对多种性结果的作用的现有证据。
结果
T 是男性性反应功能的重要调节剂。然而，在流行病学研究中，T 在性功能中的作用并不明显，因为其他因素，包括有机的、关系的和内在心理的决定因素，可以独立于雄激素状态来协调其作用。尽管如此，很明显 TRT 可以改善性欲、勃起功能和整体性满意度等几个方面的性功能。相反，关于 TRT 在改善性高潮功能方面的作用的数据更具争议性。最后，需要进一步的对照研究来调查 TRT 和 PDE5 抑制剂的联合应用。
结论
只有在存在性腺功能减退症（即总 T <12nmol/L）的情况下，TRT 才会产生积极的效果。此外，TRT 单独使用仅能有效恢复较轻形式的勃起功能障碍，而当存在更严重的血管损伤时，则需要与其他药物联合治疗。
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