Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET - FEI - División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina.
Departamento de Biología Celular, Histología, Embriología y Genética, Facultad de Medicina, Universidad de Buenos Aires, Argentina.
Am J Mens Health. 2020 May-Jun;14(3):1557988320922443. doi: 10.1177/1557988320922443.
During adolescence, androgens are responsible for the development of secondary sexual characteristics, pubertal growth, and the anabolic effects on bone and muscle mass. Testosterone is the most abundant testicular androgen, but some effects are mediated by its conversion to the more potent androgen dihydrotestosterone (DHT) or to estradiol. Androgen deficiency, requiring replacement therapy, may occur due to a primary testicular failure or secondary to a hypothalamic-pituitary disorder. A very frequent condition characterized by a late activation of the gonadal axis that may also need androgen treatment is constitutional delay of puberty. Of the several testosterone or DHT formulations commercially available, very few are employed, and none is marketed for its use in adolescents. The most frequently used androgen therapy is based on the intramuscular administration of testosterone enanthate or cypionate every 3 to 4 weeks, with initially low doses. These are progressively increased during several months or years, in order to mimic the physiology of puberty, until adult doses are attained. Scarce experience exists with oral or transdermal formulations. Preparations containing DHT, which are not widely available, are preferred in specific conditions. Oxandrolone, a non-aromatizable drug with higher anabolic than androgenic effects, has been used in adolescents with preserved testosterone production, like Klinefelter syndrome, with positive effects on cardiometabolic health and visual, motor, and psychosocial functions. The usual protocols applied for androgen therapy in boys and adolescents are discussed.
在青春期，雄激素负责第二性征的发育、青春期生长以及对骨骼和肌肉质量的合成代谢作用。睾酮是睾丸中最丰富的雄激素，但有些作用是通过其转化为更有效的雄激素二氢睾酮（DHT）或雌二醇来介导的。雄激素缺乏，需要替代治疗，可能是由于原发性睾丸衰竭或继发于下丘脑-垂体紊乱引起的。一种非常常见的特征是性腺轴的迟发性激活，也可能需要雄激素治疗，这就是体质性青春期延迟。在商业上可获得的几种睾酮或 DHT 制剂中，很少使用，也没有一种制剂用于青少年。最常使用的雄激素治疗是每 3-4 周肌内注射庚酸睾酮或环戊丙酸睾酮，初始剂量较低。这些剂量在数月或数年内逐渐增加，以模拟青春期的生理过程，直到达到成人剂量。口服或透皮制剂的经验很少。含有 DHT 的制剂，由于不广泛可用，在特定情况下更受欢迎。非芳香化药物氧雄龙具有较高的合成代谢作用和雄激素作用，已在具有保留的睾酮产生的青少年中使用，如克莱恩费尔特综合征，对心脏代谢健康以及视觉、运动和心理社会功能有积极影响。讨论了适用于男孩和青少年雄激素治疗的常用方案。
