Department of Medicine, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia.
Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia.
Ann N Y Acad Sci. 2024 Aug;1538(1):45-55. doi: 10.1111/nyas.15188. Epub 2024 Jul 22.
In epidemiological studies, lowered serum testosterone concentrations are common in men with obesity, prediabetes, and established type 2 diabetes (T2D). In men with prediabetes, lowered serum testosterone also predicts a future risk of T2D in men. Administration of testosterone consistently reduces fat mass and increases skeletal muscle mass-body compositional changes expected to be metabolically favorable. In men with established T2D, the effects of testosterone treatment on glycemic measures are inconsistent. Irrespective of baseline serum testosterone concentration in men with prediabetes or newly diagnosed early-onset T2D, testosterone treatment prescribed in conjunction with a lifestyle program has been reported to reduce the risk of T2D by 40% after 2 years, suggesting that either a lifestyle program is required to facilitate the glycemic benefit of testosterone treatment and/or that testosterone treatment has more favorable effects on glycemia in men early in the evolution or onset of the disease. The durability of the benefit and longer-term safety of testosterone treatment have not been established. Therefore, more studies are required before testosterone treatment can be recommended for the prevention and/or treatment of men with or at elevated risk of T2D who do not have hypogonadism due to an established disease of the hypothalamic-pituitary-testicular axis.
在流行病学研究中，肥胖、糖尿病前期和已确诊的 2 型糖尿病（T2D）患者的血清睾丸酮浓度往往较低。在糖尿病前期患者中，血清睾丸酮降低也预示着未来男性患 T2D 的风险。睾丸酮的应用可持续降低脂肪量，增加骨骼肌量——这是预期对代谢有益的身体成分变化。对于已确诊的 T2D 患者，睾丸酮治疗对血糖指标的影响并不一致。无论糖尿病前期或新诊断的早发性 T2D 患者的基线血清睾丸酮浓度如何，联合生活方式方案进行的睾丸酮治疗报告显示，可在 2 年内降低 40%的 T2D 风险，这表明生活方式方案有助于促进睾丸酮治疗的血糖益处，和/或睾丸酮治疗对疾病早期或发病时的男性血糖有更有利的影响。睾丸酮治疗的获益持续时间和长期安全性尚未确定。因此，在推荐睾丸酮治疗用于预防和/或治疗因下丘脑-垂体-睾丸轴的既定疾病而无性腺功能减退症的 T2D 患者或处于 T2D 风险升高的男性之前，还需要进行更多的研究。
