Department of Neurohabilitation, Oslo University Hospital, Kirkeveien 166, 0450, Oslo, Norway.
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
J Med Case Rep. 2022 Nov 18;16(1):425. doi: 10.1186/s13256-022-03651-w.
Attention deficit/hyperactivity disorder (ADHD) entails inattention, impulsivity, and restlessness at a disabling level. The pharmacological treatment of ADHD rests on the use of centrally acting stimulants, such as methylphenidate and D-amphetamine. In some patients, these drugs cause side effects that preclude their use.
We present three adult male, Caucasian, ADHD patients (24, 37, and 43 years old) whose ADHD symptoms improved during treatment with testosterone. The first patient experienced loss of libido during treatment with methylphenidate; for this, he was offered a trial of testosterone. Unexpectedly, his ADHD symptoms improved with testosterone treatment, and this effect continued with testosterone as monotherapy. The two other patients, who also had side effects from centrally acting stimulants, received testosterone monotherapy with similar results. The effect has now continued for 4.5-5 years at the same doses: 10-60 mg testosterone/day, administered as a skin gel. Prior to testosterone treatment, the patients had serum levels of testosterone in the low-normal range: 12-16 nmol/L (age-specific reference range: 10.4-32.6 nmol/L). The testosterone/sex hormone-binding globulin ratio was low in two patients (0.32 and 0.34; age-specific reference range: 0.38-1.1), suggesting low free serum levels of testosterone. Serum testosterone levels and testosterone/sex hormone-binding globulin ratios increased with testosterone treatment in all patients, but remained within reference values.
These cases suggest that a moderately reduced serum level of free testosterone may contribute to the ADHD symptoms of some adult male ADHD patients, and that testosterone treatment may be of value for these patients.
注意力缺陷多动障碍（ADHD）表现为注意力不集中、冲动和不安，达到致残程度。ADHD 的药物治疗依赖于中枢作用兴奋剂的使用，如哌甲酯和右旋苯丙胺。在一些患者中，这些药物会引起副作用，使其无法使用。
我们介绍了 3 名成年男性白人 ADHD 患者（24、37 和 43 岁），他们在接受睾酮治疗后，ADHD 症状得到改善。第一位患者在接受哌甲酯治疗时出现性欲丧失；因此，他接受了睾酮治疗试验。出乎意料的是，他的 ADHD 症状在接受睾酮治疗后得到改善，并且这种效果在单独使用睾酮时仍持续存在。另外两名患者也因中枢作用兴奋剂而出现副作用，他们接受了单独使用睾酮治疗，结果相似。目前，在相同剂量下（10-60mg 睾酮/天，作为皮肤凝胶给药），这种效果已经持续了 4.5-5 年。在接受睾酮治疗之前，患者的血清睾酮水平处于正常低值范围：12-16nmol/L（年龄特异性参考范围：10.4-32.6nmol/L）。两名患者的睾酮/性激素结合球蛋白比值较低（0.32 和 0.34；年龄特异性参考范围：0.38-1.1），提示游离血清睾酮水平较低。所有患者的血清睾酮水平和睾酮/性激素结合球蛋白比值随着睾酮治疗而增加，但仍在参考值范围内。
这些病例表明，中度降低的游离血清睾酮水平可能导致一些成年男性 ADHD 患者的 ADHD 症状，并且睾酮治疗可能对这些患者有价值。
