Walther Andreas, Seuffert Julian
Department of Biological Psychology, TU Dresden, Dresden, Germany.
Department of Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland.
World J Mens Health. 2020 Apr;38(2):178-190. doi: 10.5534/wjmh.190006. Epub 2019 Jun 4.
Although demographic statistics show that populations around the world are rapidly ageing, this rising life expectancy is accompanied by an increase in the number of people living with age-related chronic conditions, such as frailty, cognitive decline, depression, or sexual dysfunction. In men, a progressive decline in androgens occurs with increasing age, and low androgen levels are associated with age-related chronic conditions. However, androgen administration studies are inconclusive, showing differing results according to the androgen used (testosterone [T], dehydroepiandrosterone [DHEA]), the group of men examined (younger vs. older; eugonadal vs. hypogonadal) and the conditions studied (frailty, cognitive decline, depression, sexual dysfunction). In this review, the current state for the use of T and DHEA therapy in men for the age-related conditions is examined. Due to the progressive age-related decline in androgens leading to a higher rate of older men having low androgen levels, the effects of androgen treatment in elderly males will be of particular interest in this review. Dose-response relationships, the role of potential moderators, and the androgen treatment-related risk for adverse events will be discussed. Studies have suggested that T treatment - more so than DHEA treatment - may be an effective therapy against age-related chronic conditions in men with low T levels; especially older men. Such conditions include frailty, depression, or sexual dysfunction. However, T treatment does not emerge as an effective therapy against cognitive decline. Nevertheless, more high-quality, randomised controlled trials using T treatment for age-related chronic conditions are necessary if further conclusions are to be made.
尽管人口统计数据显示全球人口正在迅速老龄化，但预期寿命的延长伴随着患有与年龄相关的慢性疾病（如身体虚弱、认知衰退、抑郁症或性功能障碍）的人数增加。在男性中，雄激素水平会随着年龄的增长而逐渐下降，而低雄激素水平与年龄相关的慢性疾病有关。然而，雄激素给药研究尚无定论，根据所使用的雄激素（睾酮 [T]、脱氢表雄酮 [DHEA]）、所研究的男性群体（年轻与年长；性腺功能正常与性腺功能减退）以及所研究的疾病（身体虚弱、认知衰退、抑郁症、性功能障碍），结果各不相同。在本综述中，我们研究了在男性中使用 T 和 DHEA 疗法治疗与年龄相关疾病的现状。由于雄激素水平随着年龄的增长而逐渐下降，导致老年男性雄激素水平低的比例更高，因此雄激素治疗对老年男性的影响将是本综述特别关注的内容。我们将讨论剂量反应关系、潜在调节因素的作用以及雄激素治疗相关的不良事件风险。研究表明，与 DHEA 治疗相比，T 治疗可能是治疗 T 水平低的男性与年龄相关慢性疾病的有效疗法；尤其是老年男性。这些疾病包括身体虚弱、抑郁症或性功能障碍。然而，T 治疗并未成为治疗认知衰退的有效疗法。尽管如此，如果要得出进一步的结论，仍需要进行更多高质量的、使用 T 治疗与年龄相关慢性疾病的随机对照试验。
