University of Adelaide, Adelaide, Australia.
Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia.
Rev Endocr Metab Disord. 2022 Dec;23(6):1233-1242. doi: 10.1007/s11154-022-09746-5. Epub 2022 Jul 14.
In the absence of obesity, adverse lifestyle behaviours, and use of medication such as opioids serum testosterone concentrations decrease by only a minimal amount at least until very advanced age in most men. Obesity is heterogeneous in its phenotype, and it is the accumulation of excess adipose tissue viscerally associated with insulin resistance, dyslipidaemia, inflammation, hypothalamic leptin resistance and gliosis that underpins the functional hypogonadism of obesity. Both central (hypothalamic) and peripheral mechanisms are involved resulting in a low serum total testosterone concentration, while LH and FSH are typically in the normal range. Peripherally a decrease in serum sex hormone binding globulin (SHBG) concentration only partially explains the decrease in testosterone and there is increasing evidence for direct effects in the testis. Men with obesity associated functional hypogonadism and serum testosterone concentrations below 16 nmol/L are at increased risk of incident type 2 diabetes (T2D); high testosterone concentrations are protective. The magnitude of weight loss is linearly associated with an increase in serum testosterone concentration and with the likelihood of preventing T2D or reverting newly diagnosed disease; treatment with testosterone for 2 years increases the probability of a positive outcome from a lifestyle intervention alone by approximately 40%. Whether the additional favourable benefits of testosterone treatment on muscle mass and strength and bone density and quality in the long-term remains to be determined.
在没有肥胖、不良生活方式行为以及使用阿片类药物等药物的情况下，大多数男性的血清睾丸激素浓度至少在非常高龄时才会轻微下降。肥胖在表型上是异质的，正是与胰岛素抵抗、血脂异常、炎症、下丘脑瘦素抵抗和神经胶质增生相关的内脏脂肪堆积，导致了肥胖的功能性性腺功能减退。中枢（下丘脑）和外周机制都参与其中，导致血清总睾丸激素浓度降低，而 LH 和 FSH 通常在正常范围内。在外周，血清性激素结合球蛋白 (SHBG) 浓度的降低仅部分解释了睾丸激素的降低，并且越来越多的证据表明存在睾丸的直接作用。患有肥胖相关功能性性腺功能减退和血清睾丸激素浓度低于 16nmol/L 的男性发生 2 型糖尿病 (T2D) 的风险增加；高睾丸激素浓度具有保护作用。体重减轻的幅度与血清睾丸激素浓度的增加以及预防 T2D 或逆转新诊断疾病的可能性呈线性相关；使用睾丸激素治疗 2 年可使单独进行生活方式干预的阳性结果的可能性增加约 40%。睾丸激素治疗在长期内对肌肉质量和力量以及骨密度和质量的额外有利影响仍有待确定。
