Kabilan Apiraa, Skakkebæk Anne, Chang Simon, Gravholt Claus H
Department of Endocrinology, Aarhus University Hospital, 8200 Aarhus, Denmark.
Department of Internal Medicine, Lillebaelt Hospital, 6000 Kolding, Denmark.
J Endocr Soc. 2021 Apr 5;5(6):bvab062. doi: 10.1210/jendso/bvab062. eCollection 2021 Jun 1.
Klinefelter Syndrome (KS) is the most frequent sex chromosome disorder in males. Due to hypergonadotropic hypogonadism, treatment with testosterone replacement therapy (TRT) is commonly indicated. There are no international guidelines for the most appropriate TRT in KS.
We aimed to evaluate how different routes of testosterone administration impact testosterone-responsive variables, as well as the development of later metabolic diseases and other complications.
We conducted a retrospective study covering 5 years from 2015 to 2020. Data on TRT, biochemical parameters, bone mineral density (BMD), medications, comorbidity, and karyotyping were derived from electronic patient records and The Danish Cytogenetic Register.
A total of 147 KS males were included: 81 received injection TRT, 61 received transdermal TRT, and 5 did not receive TRT. Testosterone levels were similar in the 2 TRT groups ( = 0.9), while luteinizing hormone and follicle-stimulating hormone levels were higher in the group receiving transdermal TRT ( = 0.002). Levels of cholesterol, blood glucose, hemoglobin A1c, hemoglobin, hematocrit, liver parameters, prostate-specific antigen, and spine and hip BMD were similar in the 2 treatment groups (s > 0.05).
TRT, irrespective of route of administration, affects androgen-responsive variables similarly in males with KS. Neither long-acting injection nor transdermal gel seem to reduce the risk of metabolic diseases significantly. These results should encourage clinicians in seeking the route of administration resulting in the highest degree of adhesion to treatment based on individual patient preferences. Implementation of shared decision-making with patients may be important when choosing TRT.
克兰费尔特综合征（KS）是男性中最常见的性染色体疾病。由于高促性腺激素性性腺功能减退，通常需要进行睾酮替代疗法（TRT）治疗。目前尚无关于KS患者最合适的TRT的国际指南。
我们旨在评估不同的睾酮给药途径如何影响睾酮反应变量，以及后期代谢疾病和其他并发症的发生情况。
我们进行了一项回顾性研究，涵盖2015年至2020年的5年时间。TRT、生化参数、骨密度（BMD）、药物治疗、合并症和核型分析的数据来自电子病历和丹麦细胞遗传学登记处。
共纳入147例KS男性患者：81例接受注射用TRT，61例接受透皮TRT，5例未接受TRT。两个TRT组的睾酮水平相似（P = 0.9），而接受透皮TRT组的促黄体生成素和促卵泡生成素水平较高（P = 0.002）。两个治疗组的胆固醇、血糖、糖化血红蛋白、血红蛋白、血细胞比容、肝脏参数、前列腺特异性抗原以及脊柱和髋部BMD水平相似（P > 0.05）。
无论给药途径如何，TRT对KS男性患者雄激素反应变量的影响相似。长效注射和透皮凝胶似乎都不能显著降低代谢疾病的风险。这些结果应鼓励临床医生根据患者的个人偏好寻找能实现最高治疗依从性的给药途径。在选择TRT时，与患者共同决策可能很重要。
