性腺功能减退男性非睾酮类治疗的疗效：综述
Efficacy of Non-Testosterone-Based Treatment in Hypogonadal Men: A Review.
作者信息
Raheem Omer A, Chen Tony, Akula Kole Prasad, Greenberg Jacob, Le Tan V, Chernobylsky David, Sikka Suresh C, Walsh Thomas J
机构信息
Tulane University School of Medicine, Department of Urology, New Orleans, LA, USA.
University of Washington, Department of Urology, Seattle, WA, USA.
出版信息
Sex Med Rev. 2021 Jul;9(3):381-392. doi: 10.1016/j.sxmr.2020.08.003. Epub 2021 Apr 29.
INTRODUCTION
Although testosterone replacement therapy is an effective treatment for hypogonadism, there are safety concerns regarding potential cardiovascular risks and fertility preservation.
OBJECTIVE
To assess the effect of selective estrogen receptor modulator (SERM), aromatase inhibitor, and human chorionic gonadotropin (hCG) on total testosterone (TT) levels and hypogonadism.
METHODS
We performed a systematic literature review from 1987 to 2019 via PubMed, Cochrane review, and Web of Science. Terms used were infertility, hypogonadism, alternative to testosterone therapy, selective estrogen receptor modulator, aromatase inhibitor, and human chorionic gonadotropin. Studies that reported an effect of TT and hypogonadism after treatment of each medication were selected. Hypogonadal symptoms were assessed by the Androgen Deficiency of The Aging Male (ADAM) questionnaire. Aggregated data were analyzed via Chi-squared analysis.
RESULTS
From literature, 25 studies were selected; of which, 12 evaluated efficacy of aromatase inhibitor, 8 evaluated SERMs, and 5 evaluated hCG effects. For SERMs, 512 patients with mean age 42.3 ± 1.94 years showed mean TT before treatment vs after treatment (167.9 ± 202.8 [ng/dl] vs 366.2 ± 32.3 [ng/dl], P < .0001 [180.5-216.1 95% confidence interval {CI}]). For aromatase inhibitor, 375 patients with mean age 54.1 ± 0.67 years showed mean TT before treatment vs after treatment (167.9 ± 202.8 [ng/dl] vs 366.2 ± 32.3 [ng/dl], P < .0001 [180.5-216.1 95% CI]). SERMs also showed ADAM before treatment vs after treatment (4.95 ± 0.28 vs 5.50 ± 0.19, P < .0001 [0.523-0.581 95% CI]). For hCG, 196 patients with mean age 41.7 ± 1.5 years showed mean TT before treatment vs after treatment (284.5 ± 13.6 [ng/dl] vs 565.6 ± 39.7 [ng/dl], P < .0001 [275.2-287.0 95% CI]). In addition, hCG also showed ADAM before treatment vs after treatment (28.1 ± 2.0 vs 30.9 ± 2.3, P < .0001 [2.313 95% CI]).
CONCLUSIONS
Non-testosterone therapies are efficacious in hypogonadal men. Our results show statistically significant improvement in TT and ADAM scores in all 3 medications after treatment. Future studies are warranted to elucidate the relationship between improved hypogonadism and erectile function in the setting of non-testosterone-based treatment. Raheem OA, Chen TT, Le TV, et al. Efficacy of Non-Testosterone-Based Treatment in Hypogonadal Men: A Review. Sex Med Rev 2021;9:381-392.
引言
尽管睾酮替代疗法是治疗性腺功能减退的有效方法，但对于潜在的心血管风险和生育能力保护仍存在安全担忧。
目的
评估选择性雌激素受体调节剂（SERM）、芳香化酶抑制剂和人绒毛膜促性腺激素（hCG）对总睾酮（TT）水平和性腺功能减退的影响。
方法
我们通过PubMed、Cochrane综述和科学网对1987年至2019年的文献进行了系统回顾。使用的检索词为不育、性腺功能减退、睾酮治疗的替代方法、选择性雌激素受体调节剂、芳香化酶抑制剂和人绒毛膜促性腺激素。选择报告了每种药物治疗后TT和性腺功能减退影响的研究。性腺功能减退症状通过老年男性雄激素缺乏（ADAM）问卷进行评估。汇总数据通过卡方分析进行分析。
结果
从文献中选择了25项研究；其中，12项评估了芳香化酶抑制剂的疗效，8项评估了SERM，5项评估了hCG的效果。对于SERM，512例平均年龄为42.3±1.94岁的患者治疗前与治疗后的平均TT分别为（167.9±202.8 [ng/dl] 对366.2±32.3 [ng/dl]，P <.0001 [180.5 - 216.1 95%置信区间{CI}]）。对于芳香化酶抑制剂，375例平均年龄为54.1±0.67岁的患者治疗前与治疗后的平均TT分别为（167.9±202.8 [ng/dl] 对366.2±32.3 [ng/dl]，P <.0001 [180.5 - 216.1 95% CI]）。SERM治疗前与治疗后的ADAM评分也有差异（4.95±0.28对5.50±0.19，P <.0001 [0.523 - 0.581 95% CI]）。对于hCG，196例平均年龄为41.7±1.5岁的患者治疗前与治疗后的平均TT分别为（284.5±13.6 [ng/dl] 对565.6±39.7 [ng/dl]，P <.0001 [275.2 - 287.0 95% CI]）。此外，hCG治疗前与治疗后的ADAM评分也有差异（28.1±2.0对30.9±2.3，P <.0001 [2.313 95% CI]）。
结论
非睾酮疗法对性腺功能减退男性有效。我们的结果显示，所有3种药物治疗后TT和ADAM评分均有统计学意义的改善。未来有必要开展研究，以阐明在非睾酮治疗背景下性腺功能减退改善与勃起功能之间的关系。拉希姆·奥阿、陈婷婷、乐·特维等。非睾酮治疗对性腺功能减退男性的疗效：一项综述。性医学评论2021；9：381 - 392。
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