Cohen Jordan, Nassau Daniel E, Patel Premal, Ramasamy Ranjith
Department of Urology, University of Miami Miller School of Medicine, Miami, FL, United States.
Department of Urology, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, United States.
Front Endocrinol (Lausanne). 2020 Jan 10;10:916. doi: 10.3389/fendo.2019.00916. eCollection 2019.
Male hypogonadism, the clinical syndrome with variable symptoms associated with gonadal dysfunction, can affect men of all ages. In older males, physiologic changes of the aging testis, account for the majority of decreased testosterone levels in this population. For younger males and adolescents, the etiology of hypogonadism is commonly due to congenital or acquired conditions that disrupt the testis production of testosterone or signaling from the hypothalamic-pituitary-gonadal axis. Diagnosis of hypogonadism in younger males can be a challenge, as symptoms such as decreased libido or erectile dysfunction, common in the older men, are not usually present, and young men instead commonly complain of low energy. While an underlying congenital cause should always be considered in young men with hypogonadism, acquired conditions such as obesity, diabetes, anabolic steroid or illicit drug use have all been associated with low testosterone levels. Outside of modifying identifiable risk factors for hypogonadism, pharmacologic testosterone therapy can also lead to therapeutic dilemmas in young men who desire paternity. Topical or injectable administration of testosterone, through negative feedback on the hypothalamus and pituitary, can decrease spermatogenesis, posing an infertility risk. Other agents that can replace testosterone or increase the body's natural production of testosterone without decreasing spermatogenesis are preferred, such as intranasal testosterone, selective estrogen modulators, aromatase inhibitors or human-chorionic gonadotrophin, often used in combination. Clinicians must maintain a high level of suspicion to properly diagnose young men with hypogonadism and tailor treatment based on both the underlying etiology and fertility goals.
男性性腺功能减退是一种与性腺功能障碍相关、症状多样的临床综合征，可影响各年龄段的男性。在老年男性中，衰老睾丸的生理变化是该人群睾酮水平下降的主要原因。对于年轻男性和青少年而言，性腺功能减退的病因通常是先天性或后天性疾病，这些疾病会干扰睾丸睾酮的产生或下丘脑-垂体-性腺轴的信号传递。年轻男性性腺功能减退的诊断可能具有挑战性，因为老年男性常见的性欲减退或勃起功能障碍等症状通常不存在，年轻男性反而常抱怨精力不足。虽然对于患有性腺功能减退的年轻男性，始终应考虑潜在的先天性病因，但肥胖、糖尿病、使用合成代谢类固醇或非法药物等后天性疾病也都与低睾酮水平有关。除了改变性腺功能减退的可识别风险因素外，药物睾酮治疗对于有生育意愿的年轻男性也可能导致治疗困境。通过对下丘脑和垂体的负反馈作用，局部或注射睾酮会减少精子生成，带来不孕风险。其他能够替代睾酮或增加机体天然睾酮生成而不减少精子生成的药物更受青睐，比如鼻内睾酮、选择性雌激素调节剂、芳香化酶抑制剂或人绒毛膜促性腺激素，这些药物常联合使用。临床医生必须保持高度怀疑，以正确诊断患有性腺功能减退的年轻男性，并根据潜在病因和生育目标调整治疗方案。
