Botman Esmée, Smit Diederik L, de Ronde Willem
Department of Internal Medicine, Spaarne Gasthuis, Haarlem, the Netherlands.
Department of Internal Medicine, Elizabeth-Tweesteden Ziekenhuis, Tilburg, the Netherlands.
Clin Endocrinol (Oxf). 2023 Apr;98(4):469-472. doi: 10.1111/cen.14686. Epub 2022 Feb 17.
Androgen abuse is relatively common amongst young (amateur) bodybuilders. After cessation, the hypothalamic-pituitary-gonadal (HPG) axis-which has been suppressed by the androgens-needs time to recover. The endogenous testosterone production often recovers within 3 months, however, prolonged or permanent post-androgen abuse hypogonadism (PPAAH) has been described. There is no widely accepted definition nor is its pathogenesis completely elucidated. To date it is a subject of debate whether PPAAH is a separate entity, reflecting irreversible damage to essential components of the HPG axis inflicted by long-term exposure to high doses of androgens. Alternately, it may be the result of longer than expected suppressive effects of androgen depots, undisclosed ongoing androgen abuse or undiagnosed unrelated disorders. Due to the lack of scientific evidence, the management of PPAAH is challenging. By combining clinical experience with evidence from the recent literature, a suggested outline of the management of androgen-abuse-induced hypogonadism are given.
雄激素滥用在年轻（业余）健美运动员中较为常见。停用后，被雄激素抑制的下丘脑-垂体-性腺（HPG）轴需要时间恢复。内源性睾酮的产生通常在3个月内恢复，然而，已有文献描述了长期或永久性雄激素滥用后性腺功能减退（PPAAH）。目前尚无广泛接受的定义，其发病机制也未完全阐明。迄今为止，PPAAH是否为一个独立的实体，反映长期暴露于高剂量雄激素对HPG轴关键成分造成的不可逆损害，仍是一个有争议的话题。或者，它可能是雄激素储库抑制作用持续时间超过预期、未公开的持续雄激素滥用或未诊断出的无关疾病的结果。由于缺乏科学证据，PPAAH的管理具有挑战性。结合临床经验和近期文献证据，给出了雄激素滥用所致性腺功能减退管理的建议大纲。
