睾酮缺乏症的诊断与治疗：2018 年里斯本国际性医学咨询会议更新建议。

Diagnosis and Treatment of Testosterone Deficiency: Updated Recommendations From the Lisbon 2018 International Consultation for Sexual Medicine.

机构信息

Men's Health Boston, Department of Surgery (Urology), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

Boston University Medical Center, Boston, MA, USA.

出版信息

Sex Med Rev. 2019 Oct;7(4):636-649. doi: 10.1016/j.sxmr.2019.06.003. Epub 2019 Jul 24.

DOI:10.1016/j.sxmr.2019.06.003

PMID:31351915

Abstract

INTRODUCTION

The International Consultation for Sexual Medicine met in Lisbon in 2018 to review updated recommendations regarding testosterone deficiency (TD) and its treatment.

AIM

To provide updated clinical recommendations regarding TD and its treatment.

METHODS

A Medline search was performed for testosterone (T) articles published since the 2015 International Consultation for Sexual Medicine report. Recommendations were presented at the Lisbon meeting, and feedback was incorporated into final recommendations.

MAIN OUTCOME MEASURES

Selected topics for these updates included terminology, clinical diagnosis, sexual function, prostate, cardiovascular, metabolic conditions, anemia, bone health, and therapeutic options.

RESULTS

The terms "testosterone deficiency" (TD) and "testosterone therapy" (TTh) were endorsed over numerous competing terms. The wide interindividual variability of sex hormone binding globulin concentrations influences the interpretation of total T concentrations. Symptoms of T deficiency more closely follow free T than total T concentrations. Symptomatic men with total T <350 ng/dL or free T <65-100 pg/mL may reasonably undergo a trial of T therapy. An empirical 6-month trial of TTh may be considered in men with strongly suggestive symptoms and values above these thresholds. Morning blood testing is indicated in men <40 years of age. Men >40 years may undergo initial afternoon testing, as long as confirmatory morning blood tests are later obtained. High-level evidence demonstrates TTh in men with TD improves sexual desire and erectile function. The weight of evidence indicates that TTh is not associated with increased risk of prostate cancer, cardiovascular events, or worsening lower urinary tract symptoms. Bone density and anemia are improved with TTh. Obesity and type 2 diabetes are associated with TD, and TTh provides consistent improvement in metabolic parameters. Multiple safe and effective therapeutic options are available to treat men with TD.

CONCLUSIONS

Treatment of TD offers multiple benefits for sexual symptoms as well as for general health, without compelling evidence for increased risk of prostate cancer or cardiovascular events. Morgentaler A, Traish A, Hackett G, et al. Diagnosis and Treatment of Testosterone Deficiency: Updated Recommendations From the Lisbon 2018 International Consultation for Sexual Medicine. Sex Med Rev 2019;7:636-649.

摘要

引言

国际性医学协会于 2018 年在里斯本开会，审议关于睾丸激素缺乏症（TD）及其治疗的最新建议。

目的

提供关于 TD 及其治疗的最新临床建议。

方法

对自 2015 年国际性医学协会报告以来发表的关于睾丸激素（T）的文章进行了 Medline 搜索。建议在里斯本会议上提出，并将反馈意见纳入最终建议。

主要观察指标

这些更新的主题包括术语、临床诊断、性功能、前列腺、心血管、代谢状况、贫血、骨骼健康和治疗选择。

结果

“睾丸激素缺乏症”（TD）和“睾丸激素治疗”（TTh）这两个术语得到了广泛认可，而许多竞争性术语则被否决。性激素结合球蛋白浓度的个体间差异很大，影响了总 T 浓度的解释。T 缺乏的症状更接近游离 T，而不是总 T 浓度。总 T <350ng/dL 或游离 T <65-100pg/mL 的有症状男性可能合理地接受 T 治疗试验。对于有强烈提示症状且值高于这些阈值的男性，可考虑进行 6 个月的 TTh 经验性试验。<40 岁的男性应进行晨间血液检测。>40 岁的男性可先进行下午检测，只要随后获得确认性晨间血液检测结果。高水平的证据表明，TD 男性的 TTh 可改善性欲和勃起功能。有大量证据表明，TTh 与前列腺癌、心血管事件或下尿路症状恶化的风险增加无关。TTh 可改善骨密度和贫血。肥胖和 2 型糖尿病与 TD 相关，TTh 可使代谢参数持续改善。有多种安全有效的治疗方法可用于治疗 TD 男性。

结论

TD 治疗为性功能和整体健康带来多种益处，而没有增加前列腺癌或心血管事件风险的令人信服的证据。Morgentaler A, Traish A, Hackett G, et al. 睾丸激素缺乏症的诊断和治疗：来自 2018 年里斯本国际性医学协会的最新建议。性医学评论 2019;7:636-649。