Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile di Baggiovara, Modena, Italy.
Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile di Baggiovara, Modena, Italy.
Vitam Horm. 2021;115:333-366. doi: 10.1016/bs.vh.2020.12.014. Epub 2021 Feb 13.
Over the past two decades several large cohort studies have been performed to disclose the changes of sex hormone in elderly and their clinical significance. Beyond the decline of total testosterone, aging is accompanied by a sex hormone binding globulin (SHBG) increase, a steeper free testosterone decline, while gonadotropins may be increased or inappropriately normal, with important contribution of comorbidities (e.g., obesity) to these changes. Actually, it has become firm the concept that the biochemical finding of testosterone deficiency alone is not sufficient for diagnosing hypogonadism in older men. The definition of late-onset hypogonadism (LOH) includes low serum testosterone levels coupled with signs and symptoms related to hypogonadism. Indeed, the combination of multiple factors all contributing to the testosterone decline, with other concurrent comorbidities further overlapping, makes the clinical correlates of LOH highly heterogeneous. For all these reasons both the diagnosis and the therapeutic management of LOH, especially the decision about starting testosterone replacement treatment, remain challenging.
在过去的二十年中，已经进行了几项大型队列研究，以揭示老年人群中性激素的变化及其临床意义。除了总睾酮的下降外，衰老伴随着性激素结合球蛋白 (SHBG) 的增加，游离睾酮的下降更为陡峭，而促性腺激素可能增加或不适当的正常，合并症（如肥胖）对这些变化有重要贡献。实际上，已经确立了这样一个概念，即仅存在睾酮缺乏的生化发现不足以诊断老年男性的性腺功能减退症。迟发性性腺功能减退症 (LOH) 的定义包括血清睾酮水平降低，伴有与性腺功能减退相关的体征和症状。事实上，多种因素共同导致睾酮下降，其他同时存在的合并症进一步重叠，使得 LOH 的临床相关性高度异质。由于所有这些原因，LOH 的诊断和治疗管理，特别是关于开始睾酮替代治疗的决策，仍然具有挑战性。
