Dobs Adrian Sandra, Campbell Kevin James
Division of Endocrinology, Diabetes and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Urology, University of Florida, Gainesville, FL, USA.
Int J Gen Med. 2022 Oct 7;15:7719-7733. doi: 10.2147/IJGM.S364189. eCollection 2022.
The incidence of testosterone deficiency and the use of testosterone therapy have increased in recent years, and currently the majority of testosterone prescriptions in the United States and Canada are written by primary care physicians. Meanwhile, the range of available testosterone therapy formulations has widened to include buccal tablets, intramuscular injections, transdermal gels, intranasal gel, subcutaneous injections, oral capsules, and subdermal pellets, each with unique pharmacokinetic and clinical characteristics. Despite the growing use of testosterone therapy and its overall efficacy and safety as demonstrated in clinical trials, concerns exist about the potential impact of testosterone therapy on spermatogenesis and fertility, development of prostate cancer, and risk of polycythemia and cardiovascular events. In addition, ongoing research aims to better characterize the effects of testosterone therapy in specific populations, such as patients aged 65 years and older, patients with obesity and type 2 diabetes, and transgender patients. The range of treatment options and the diversity of patients' goals, preferences, comorbidities, and risk factors necessitate an individualized approach to testosterone therapy that considers each patient's clinical needs alongside the distinct features of different testosterone formulations.
近年来，睾酮缺乏症的发病率以及睾酮疗法的使用均有所增加，目前在美国和加拿大，大多数睾酮处方是由初级保健医生开具的。与此同时，可用的睾酮治疗制剂范围已经扩大，包括颊含片、肌肉注射剂、透皮凝胶、鼻内凝胶、皮下注射剂、口服胶囊和皮下植入丸剂，每种制剂都有独特的药代动力学和临床特征。尽管睾酮疗法的使用日益增加，并且临床试验已证明其总体疗效和安全性，但人们仍担心睾酮疗法对精子发生和生育能力、前列腺癌发展以及红细胞增多症和心血管事件风险的潜在影响。此外，正在进行的研究旨在更好地描述睾酮疗法在特定人群中的效果，例如65岁及以上的患者、肥胖和2型糖尿病患者以及跨性别患者。治疗选择的范围以及患者目标、偏好、合并症和风险因素的多样性，使得睾酮疗法需要采取个性化方法，在考虑不同睾酮制剂独特特征的同时，兼顾每个患者的临床需求。
