Department of Endocrinology, University Hospitals Leuven, B-3000 Leuven, Belgium.
Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KULeuven, B-3000 Leuven, Belgium.
Int J Mol Sci. 2020 Dec 22;22(1):21. doi: 10.3390/ijms22010021.
Central hypogonadism is a clinical condition, characterized by sexual symptoms and low serum testosterone levels, due to an impaired function of the hypothalamus or pituitary gland. Testosterone replacement therapy (TRT) is the standard treatment for hypogonadism, but it has some disadvantages. TRT is not a good option in men wishing to preserve fertility, nor in men with (a high risk of) prostate cancer, polycythemia, thrombophilia and severe cardiovascular disease. In this review, we discuss alternative treatments for central hypogonadism. If reversible causes are present, non-pharmacological interventions can be therapeutic. Gonadotropins are a good alternative to TRT when fertility is desired in the near future though they require frequent injections. Clomiphene citrate and tamoxifen seem to be a safe alternative for the treatment of functional central hypogonadism in men, as several studies reported a significant increase in testosterone levels with these drugs. However, their use is off-label and data supporting the efficacy of clomiphene citrate and tamoxifen on hypogonadal symptoms are insufficient. For this reason, clomiphene citrate and tamoxifen should not be used in routine clinical practice to treat sexual symptoms in men with central hypogonadism.
中枢性性腺功能减退症是一种临床病症，其特征为出现性症状和血清睾酮水平降低，这是由于下丘脑或垂体功能受损所致。睾酮替代疗法（TRT）是治疗性腺功能减退症的标准方法，但它也存在一些缺点。对于希望保留生育能力的男性，以及患有（高风险的）前列腺癌、红细胞增多症、血栓形成倾向和严重心血管疾病的男性，TRT 并不是一个好的选择。在这篇综述中，我们讨论了中枢性性腺功能减退症的替代治疗方法。如果存在可逆的病因，非药物干预可能具有治疗作用。如果在不久的将来有生育需求，促性腺激素是 TRT 的一个很好的替代方法，尽管它们需要频繁注射。氯米芬和他莫昔芬似乎是治疗男性功能性中枢性性腺功能减退症的安全替代方法，因为几项研究报告称这些药物可显著提高睾酮水平。然而，它们的使用是超适应证的，并且支持氯米芬和他莫昔芬对性腺功能减退症状疗效的数据不足。因此，在常规临床实践中，不应使用氯米芬和他莫昔芬来治疗患有中枢性性腺功能减退症的男性的性症状。
