Fallara Giuseppe, Pozzi Edoardo, Corsini Christian, Belladelli Federico, Boeri Luca, Capogrosso Paolo, Montorsi Francesco, Salonia Andrea
Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy.
Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
Best Pract Res Clin Endocrinol Metab. 2022 Jul;36(4):101662. doi: 10.1016/j.beem.2022.101662. Epub 2022 Apr 22.
In this narrative review we provide an overview of the current literature on male hypogonadism and related comorbidities, also depicting the role of testosterone therapy (TTh) in the various settings. Male hypogonadism has been associated with major comorbidities such as type 2 diabetes mellitus, obesity and cardiovascular diseases, promoting a vicious cycle that may lead to further hypogonadism. The biological underpinnings of this association are currently under investigations, but clearly emerges the relevance of the hypothalamic-pituitary-gonadal axis. Hypogonadism has also been associated with increased risk of mortality. As such, TTh has the potential to oppose these patterns and improve cardiovascular and metabolic health in hypogonadal men. Clinical and observational data suggest that in males with hypogonadism, TTh, together with lifestyle changes and diabetes medications, may improve glycemia, reduce risk of progression to diabetes and provides positive effects on cardiovascular risk. Conversely, available data does not fully support any increased risk of prostate cancer in men under TTh. Of clinical relevance, a possible harmful role of hypogonadal status in men with COVID-19 eventually emerged.
在这篇叙述性综述中，我们概述了当前关于男性性腺功能减退及其相关合并症的文献，并描述了睾酮治疗（TTh）在各种情况下的作用。男性性腺功能减退与2型糖尿病、肥胖症和心血管疾病等主要合并症相关，从而形成一个恶性循环，可能导致进一步的性腺功能减退。这种关联的生物学基础目前正在研究中，但下丘脑-垂体-性腺轴的相关性已清晰显现。性腺功能减退还与死亡风险增加有关。因此，睾酮治疗有潜力对抗这些模式，并改善性腺功能减退男性的心血管和代谢健康。临床和观察数据表明，在性腺功能减退的男性中，睾酮治疗与生活方式改变及糖尿病药物治疗相结合，可能改善血糖水平，降低患糖尿病的风险，并对心血管风险产生积极影响。相反，现有数据并不完全支持接受睾酮治疗的男性患前列腺癌的风险会增加。具有临床相关性的是，性腺功能减退状态在感染新型冠状病毒肺炎的男性中最终可能发挥有害作用。
