Madsen Milou Cecilia, Heijer Martin den, Pees Claudia, Biermasz Nienke R, Bakker Leontine E H
Department of Internal Medicine and Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
Walaeus Library, Leiden University Medical Center, Leiden, the Netherlands.
Endocr Connect. 2022 Jul 25;11(8). doi: 10.1530/EC-22-0112. Print 2022 Aug 1.
Testosterone therapy is the cornerstone in the care of men with hypogonadism and transgender males. Gel and intramuscular injections are most frequently used and are registered and included in the international guidelines. The specific preparation should be selected according to the patient's preference, cost, availability, and formulation-specific properties. As the majority of men with hypogonadism and transgender males require lifelong treatment with testosterone, it is important to utilize a regimen that is effective, safe, inexpensive, and convenient to use with optimal mimicking of the physiological situation. This systematic review reviews current literature on differences between the three most used testosterone preparations in adult men with hypogonadism and transgender males. Although it appeared hardly any comparative studies have been carried out, there are indications of differences between the preparations, for example, on the stability of testosterone levels, hematocrit, bone mineral density, and patient satisfaction. However, there are no studies on the effects of testosterone replacement on endpoints such as cardiovascular disease in relation to hematocrit or osteoporotic fractures in relation to bone mineral density. The effect of testosterone therapy on health-related quality of life is strongly underexposed in the reviewed studies, while this is a highly relevant outcome measure from a patient perspective. In conclusion, current recommendations on testosterone treatment appear to be based on data primarily from non-randomized clinical studies and observational studies. The availability of reliable comparative data between the different preparations will assist in the process of individual decision-making to choose the most suitable formula.
睾酮疗法是性腺功能减退男性和跨性别男性治疗的基石。凝胶和肌肉注射是最常用的方法，已注册并被纳入国际指南。具体制剂应根据患者的偏好、成本、可及性以及制剂的特定特性来选择。由于大多数性腺功能减退男性和跨性别男性需要终身接受睾酮治疗，因此采用一种有效、安全、廉价且使用方便、能最佳模拟生理状况的治疗方案非常重要。本系统评价回顾了关于成年性腺功能减退男性和跨性别男性中三种最常用睾酮制剂差异的当前文献。尽管几乎没有进行任何比较研究，但有迹象表明这些制剂之间存在差异，例如在睾酮水平稳定性、血细胞比容、骨矿物质密度和患者满意度方面。然而，尚无关于睾酮替代治疗对诸如与血细胞比容相关的心血管疾病或与骨矿物质密度相关的骨质疏松性骨折等终点影响的研究。在所回顾的研究中，睾酮疗法对健康相关生活质量的影响严重未得到充分探讨，而从患者角度来看，这是一个高度相关的结局指标。总之，当前关于睾酮治疗的建议似乎主要基于非随机临床研究和观察性研究的数据。不同制剂之间可靠比较数据的可得性将有助于个体决策过程，以选择最合适的配方。
