International Scientific Institute “Paul VI”, Rome, Italy
Area Endocrino-Metabolica e Dermo-Reumatologica, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
Protein Pept Lett. 2020;27(12):1186-1191. doi: 10.2174/0929866527666200505214021.
Male hypogonadism is "a clinical syndrome that results from failure of the testis to produce physiological concentrations of testosterone and/or a normal number of spermatozoa due to pathology at one or more levels of the hypothalamic- pituitary-testicular axis". The diagnostic protocol of male hypogonadism includes accurate medical history, physical exam, as well as hormone assays and instrumental evaluation. Basal hormonal evaluation of serum testosterone, LH, and FSH is important in the evaluation of diseases of the hypothalamus-pituitary-testis axis. Total testosterone levels < 8 nmol/l profoundly suggest the diagnosis of hypogonadism. An inadequate androgen status is moreover possible if the total testosterone levels are 8-12 nmol/L. In this "grey zone" the diagnosis of hypogonadism is debated and the appropriateness for treating these patients with testosterone should be fostered by symptoms, although often non-specific. Up to now, no markers of androgen tissue action can be used in clinical practice. The identification of markers of androgens action might be useful in supporting diagnosis, Testosterone Replacement Treatment (TRT) and clinical follow-up. The aim of this review is to analyze the main findings of recent studies in the field of discovering putative diagnostic markers of male hypogonadism in seminal plasma by proteomic techniques. The identified proteins might represent a "molecular androtest" useful as a seminal fingerprint of male hypogonadism, for the diagnosis of patients with moderate grades of testosterone reduction and in the follow-up of testosterone replacement treatment.
男性性腺功能减退症是“由于下丘脑-垂体-睾丸轴的一个或多个水平的病变，导致睾丸无法产生生理浓度的睾酮和/或正常数量的精子而引起的临床综合征”。男性性腺功能减退症的诊断方案包括准确的病史、体格检查以及激素检测和仪器评估。血清睾酮、LH 和 FSH 的基础激素评估对下丘脑-垂体-睾丸轴疾病的评估很重要。总睾酮水平<8nmol/L 强烈提示性腺功能减退症的诊断。如果总睾酮水平为 8-12nmol/L，则雄激素状态不足也是可能的。在这个“灰色地带”，性腺功能减退症的诊断存在争议，并且应该通过症状来判断是否需要对这些患者进行睾酮治疗，尽管这些症状往往是非特异性的。到目前为止，在临床实践中还没有可以使用的雄激素组织作用标志物。雄激素作用标志物的鉴定可能有助于支持诊断、睾酮替代治疗（TRT）和临床随访。本综述的目的是分析最近在通过蛋白质组学技术发现精液中男性性腺功能减退症潜在诊断标志物方面的主要研究结果。鉴定出的蛋白质可能代表一种“分子雄激素测试”，可作为男性性腺功能减退症的精液指纹，用于诊断睾酮降低程度中等的患者，并在睾酮替代治疗的随访中使用。
