Krysiak Robert, Kowalcze Karolina, Szkróbka Witold, Okopień Bogusław
Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Medyków 18, 40-752 Katowice, Poland.
Department of Pediatrics in Bytom, Faculty of Health Sciences in Katowice, Medical University of Silesia, Stefana Batorego 15, 41-902 Bytom, Poland.
Nutrients. 2025 Mar 13;17(6):1013. doi: 10.3390/nu17061013.
Low testosterone levels and low vitamin D status are associated with increased cardiometabolic risk. The purpose of this study was to investigate whether vitamin D status determines the cardiometabolic effects of testosterone replacement therapy. The study population consisted of three groups of men with late-onset hypogonadism: vitamin D-naive individuals with 25-hydroxyvitamin D levels between 20 and 30 ng/mL (group I), males with 25-hydroxyvitamin D levels between 30 and 60 ng/mL receiving vitamin D supplementation because of previous low vitamin D status (group II), and vitamin D-naïve subjects with 25-hydroxyvitamin D levels between 30 and 60 ng/mL (group III). Circulating levels of total testosterone, 25-hydroxyvitamin D, glucose, insulin, lipids, uric acid, high-sensitivity C-reactive protein (hsCRP), homocysteine, fibrinogen, and urinary albumin-to-creatinine ratio (UACR) were assessed before and six months after intramuscular testosterone administration (250 mg every three weeks). Group I differed from the remaining groups in baseline values of 25-hydroxyvitamin D, hsCRP, homocysteine, fibrinogen, UACR, and the Framingham Risk Score. In all three groups, testosterone injections increased plasma testosterone levels and had a neutral effect on 25-hydroxyvitamin D concentration. In groups II and III, the drug improved insulin sensitivity and reduced LDL cholesterol, uric acid, hsCRP, homocysteine, fibrinogen, and UACR. In group I, the impact of testosterone was limited to a small decrease in HDL cholesterol and hsCRP. Only in groups II and III did testosterone reduce the Framingham Risk Score. There were no differences in the strength of testosterone action between both groups. In groups II and III, the replacement-induced changes in insulin sensitivity, LDL cholesterol, uric acid, hsCRP, homocysteine, fibrinogen, UACR, and the Framingham Risk Score positively correlated with 25-hydroxyvitamin D concentration. The study results suggest that the cardiometabolic effects of exogenous testosterone in men with testosterone deficiency may be determined by vitamin D status.
低睾酮水平和低维生素D状态与心血管代谢风险增加有关。本研究的目的是调查维生素D状态是否决定睾酮替代疗法的心血管代谢效应。研究人群包括三组迟发性性腺功能减退男性：25-羟基维生素D水平在20至30 ng/mL之间的未补充过维生素D的个体（第一组）；因既往维生素D水平低而接受维生素D补充、25-羟基维生素D水平在30至60 ng/mL之间的男性（第二组）；以及25-羟基维生素D水平在30至60 ng/mL之间的未补充过维生素D的受试者（第三组）。在肌肉注射睾酮（每三周250 mg）前及注射后六个月，评估总睾酮、25-羟基维生素D、葡萄糖、胰岛素、脂质、尿酸、高敏C反应蛋白（hsCRP）、同型半胱氨酸、纤维蛋白原的循环水平以及尿白蛋白与肌酐比值（UACR）。第一组在25-羟基维生素D、hsCRP、同型半胱氨酸、纤维蛋白原、UACR和弗雷明汉风险评分的基线值方面与其余组不同。在所有三组中，睾酮注射均提高了血浆睾酮水平，且对25-羟基维生素D浓度无影响。在第二组和第三组中，该药物改善了胰岛素敏感性，降低了低密度脂蛋白胆固醇、尿酸、hsCRP、同型半胱氨酸、纤维蛋白原和UACR。在第一组中，睾酮的影响仅限于高密度脂蛋白胆固醇和hsCRP略有降低。只有在第二组和第三组中，睾酮才降低了弗雷明汉风险评分。两组之间睾酮作用的强度没有差异。在第二组和第三组中，替代治疗引起的胰岛素敏感性、低密度脂蛋白胆固醇、尿酸、hsCRP、同型半胱氨酸、纤维蛋白原、UACR和弗雷明汉风险评分的变化与25-羟基维生素D浓度呈正相关。研究结果表明，睾酮缺乏男性中外源性睾酮的心血管代谢效应可能由维生素D状态决定。
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