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[睾酮——老年男性的“燃料”?]

[Testosterone-"Fuel" for old men?].

作者信息

Zitzmann Michael

机构信息

Klinische Andrologie des Centrum für Reproduktionsmedizin und Andrologie, Universitätsklinikum Münster, Domagkstr. 11, 48149, Münster, Deutschland.

出版信息

Inn Med (Heidelb). 2025 Jan;66(1):114-123. doi: 10.1007/s00108-024-01824-x. Epub 2024 Dec 21.

DOI:10.1007/s00108-024-01824-x
PMID:39709322
Abstract

Testosterone is a natural hormone which is an essential factor to maintain the physical and emotional well-being in men, regardless of age. Male hypogonadism is an endocrinal condition of testosterone deficiency with the potential to cause multiple physical complaints and psychosocial problems. The condition can be of primary (due to testicular injury), secondary (due to diseases of the hypothalamus or pituitary gland) or functional nature (due to comorbidities, such as inflammatory diseases, obesity, type 2 diabetes mellitus). Testosterone deficiency causes problems of a sexual nature, promotes metabolic disequilibrium and can impair physical abilities (reduction in muscle mass, increase in fat mass). In addition, in the condition of hypogonadism depression, osteoporosis and/or anemia often develop. A testosterone replacement therapy should not be initiated in cases of a desire to have children, unclear processes of the prostate glands or mammary glands or an elevated hematocrit value. The diagnosis as well as treatment and monitoring of the treatment should follow the international guidelines and then a clear improvement in the abovenamed complaints can be expected. Particularly functional hypogonadism, which is mostly but not exclusively diagnosed in older men, always requires treatment of the underlying comorbidity prior to starting testosterone administration.

摘要

睾酮是一种天然激素,是维持男性身心健康的重要因素,无论年龄大小。男性性腺功能减退是一种睾酮缺乏的内分泌疾病,有可能导致多种身体不适和心理社会问题。这种疾病可能是原发性的(由于睾丸损伤)、继发性的(由于下丘脑或垂体疾病)或功能性的(由于合并症,如炎症性疾病、肥胖症、2型糖尿病)。睾酮缺乏会导致性方面的问题,促进代谢失衡,并可能损害身体能力(肌肉量减少,脂肪量增加)。此外,在性腺功能减退的情况下,常出现抑郁症、骨质疏松症和/或贫血。在有生育愿望、前列腺或乳腺情况不明或血细胞比容值升高的情况下,不应开始睾酮替代疗法。诊断以及治疗和治疗监测应遵循国际指南,这样上述不适有望得到明显改善。特别是功能性性腺功能减退,大多但并非仅在老年男性中诊断出来,在开始给予睾酮之前,总是需要先治疗潜在的合并症。

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本文引用的文献

1
Associations of Testosterone and Related Hormones With All-Cause and Cardiovascular Mortality and Incident Cardiovascular Disease in Men : Individual Participant Data Meta-analyses.雄激素和相关激素与男性全因和心血管死亡率及心血管疾病发病的关联:个体参与者数据荟萃分析。
Ann Intern Med. 2024 Jun;177(6):768-781. doi: 10.7326/M23-2781. Epub 2024 May 14.
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Cardiovascular safety of testosterone replacement therapy in men: an updated systematic review and meta-analysis.男性睾酮替代疗法的心血管安全性:一项更新的系统评价和荟萃分析。
Expert Opin Drug Saf. 2024 May;23(5):565-579. doi: 10.1080/14740338.2024.2337741. Epub 2024 May 6.
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Novel reference range values for serum testosterone: a cross-sectional study of 200,000 males.
血清睾酮的新型参考范围值:一项涉及 20 万名男性的横断面研究。
J Endocrinol Invest. 2024 Sep;47(9):2261-2268. doi: 10.1007/s40618-024-02319-0. Epub 2024 Feb 22.
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Testosterone Treatment and Fractures in Men with Hypogonadism.雄激素治疗与性腺功能减退症男性的骨折
N Engl J Med. 2024 Jan 18;390(3):203-211. doi: 10.1056/NEJMoa2308836.
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Depressive Syndromes in Men With Hypogonadism in the TRAVERSE Trial: Response to Testosterone-Replacement Therapy.TRAVERSE 试验中患有性腺功能减退症男性的抑郁综合征:对睾酮替代疗法的反应。
J Clin Endocrinol Metab. 2024 Jun 17;109(7):1814-1826. doi: 10.1210/clinem/dgae026.
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Effect of Testosterone Replacement Therapy on Sexual Function and Hypogonadal Symptoms in Men with Hypogonadism.雄激素替代疗法对性腺功能减退症男性性功能和性腺功能减退症状的影响。
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Cardiovascular Safety of Testosterone-Replacement Therapy.睾酮替代疗法的心血管安全性。
N Engl J Med. 2023 Jul 13;389(2):107-117. doi: 10.1056/NEJMoa2215025. Epub 2023 Jun 16.
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The HEAT-Registry (HEmatopoietic Affection by Testosterone): comparison of a transdermal gel vs long-acting intramuscular testosterone undecanoate in hypogonadal men.HEAT 注册研究(睾酮对造血的影响):性腺功能减退男性中透皮凝胶与长效肌内注射十一酸睾酮的比较
Aging Male. 2022 Dec;25(1):134-144. doi: 10.1080/13685538.2022.2063830.
9
Effect of Testosterone Treatment on Bone Microarchitecture and Bone Mineral Density in Men: A 2-Year RCT.睾酮治疗对男性骨微结构和骨密度的影响:一项为期 2 年的 RCT 研究。
J Clin Endocrinol Metab. 2021 Jul 13;106(8):e3143-e3158. doi: 10.1210/clinem/dgab149.
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Testosterone treatment to prevent or revert type 2 diabetes in men enrolled in a lifestyle programme (T4DM): a randomised, double-blind, placebo-controlled, 2-year, phase 3b trial.生活方式干预项目中纳入的男性接受睾酮治疗以预防或逆转 2 型糖尿病(T4DM):一项随机、双盲、安慰剂对照、为期 2 年的 3b 期试验。
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