Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Faculty of Medicine, General Sir John Kotelawala Defence University, Colombo, Sri Lanka.
Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
Lancet Diabetes Endocrinol. 2024 Oct;12(10):761-774. doi: 10.1016/S2213-8587(24)00199-2. Epub 2024 Aug 16.
Organic male hypogonadism due to irreversible hypothalamic-pituitary-testicular (HPT) pathology is easily diagnosed and treated with testosterone-replacement therapy. However, controversy surrounds the global practice of prescribing testosterone to symptomatic men with low testosterone and non-gonadal factors reducing health status, such as obesity, type 2 diabetes, and ageing (ie, functional hypogonadism), but without identifiable HPT axis pathology. Health optimisation remains the gold-standard management strategy. Nevertheless, in the last decade large clinical trials and an individual patient data meta-analysis of smaller clinical trials confirmed that testosterone therapy induces modest, yet statistically significant, improvements in sexual function without increasing short-term to medium-term cardiovascular or prostate cancer risks in men with functional hypogonadism. Although testosterone improves bone mineral density and insulin sensitivity in these men, trials from the last decade suggest insufficient evidence to determine the safety and effectiveness of use of this hormone for the prevention of fractures or type 2 diabetes. This Review discusses the pathogenesis and diagnosis of male hypogonadism and appraises the evidence underpinning the management of this condition.
由于下丘脑-垂体-睾丸（HPT）轴不可逆的病理变化导致的男性性腺功能减退症很容易被诊断和治疗，通过补充睾酮即可。然而，目前对于因非性腺因素导致健康状况下降（如肥胖、2 型糖尿病和衰老，即功能性性腺功能减退症）而出现低睾酮症状的男性，全球范围内应用睾酮治疗存在争议，这些患者并没有明确的 HPT 轴病理变化。健康优化仍然是黄金标准的管理策略。然而，在过去的十年中，大型临床试验和对较小临床试验的个体患者数据进行的荟萃分析证实，睾酮治疗可适度但具有统计学意义地改善性功能，而不会增加功能性性腺功能减退症男性的短期至中期心血管或前列腺癌风险。尽管睾酮可改善这些男性的骨密度和胰岛素敏感性，但过去十年的试验表明，尚无足够的证据确定该激素用于预防骨折或 2 型糖尿病的安全性和有效性。这篇综述讨论了男性性腺功能减退症的发病机制和诊断，并评估了支持这种治疗方法的证据。
