Behre H M, Kliesch S, Leifke E, Link T M, Nieschlag E
Institute of Reproductive Medicine, University, Münster, Germany.
J Clin Endocrinol Metab. 1997 Aug;82(8):2386-90. doi: 10.1210/jcem.82.8.4163.
In both men and women, a decrease in bone mineral density (BMD) is a major symptom of hypogonadism. Although the effects of estrogens on osteoporosis in women are well documented, comparatively little is known about the effects of long term testosterone substitution on BMD in hypogonadal men. Therefore, we studied BMD in 72 hypogonadal patients (37 men with primary and 35 men with secondary hypogonadism) under testosterone substitution therapy that continued for up to 16 yr. Thirty-two of these men were also seen before initiation of therapy. At annual intervals, trabecular BMD of the lumbar spine was measured by quantitative computed tomography, a true volumetric and reproducible method for long term serial BMD measurements. Serum levels of testosterone increased to the normal range in all androgen-treated hypogonadal men. The most significant increase in BMD was seen during the first year of testosterone treatment in previously untreated patients, when BMD increased from 95.2 +/- 5.9 to 120.0 +/- 6.1 mg/cm3 hydroxyapatite (mean +/- SE). Long term testosterone treatment maintained BMD in the age-dependent reference range in all 72 hypogonadal men, independent of the type of hypogonadism. Transdermal testosterone patches applied to the scrotum were as effective in normalizing BMD as im testosterone enanthate injections. In summary, testosterone therapy increases BMD in hypogonadal men regardless of age. The greatest increase is seen during the first year of treatment in previously untreated patients with low initial BMD. In hypogonadal men, BMD can be normalized and maintained in the normal range by continuous, long term testosterone substitution.
在男性和女性中，骨矿物质密度（BMD）降低都是性腺功能减退的主要症状。虽然雌激素对女性骨质疏松症的影响已有充分记录，但对于长期睾酮替代疗法对性腺功能减退男性骨矿物质密度的影响却知之甚少。因此，我们对72例性腺功能减退患者（37例原发性性腺功能减退男性和35例继发性性腺功能减退男性）进行了研究，这些患者接受了长达16年的睾酮替代治疗。其中32名男性在治疗开始前也接受了检查。每年通过定量计算机断层扫描测量腰椎的小梁骨矿物质密度，这是一种用于长期连续骨矿物质密度测量的真正的体积测量且可重复的方法。所有接受雄激素治疗的性腺功能减退男性的血清睾酮水平均升高至正常范围。在睾酮治疗的第一年，之前未接受治疗的患者骨矿物质密度增加最为显著，此时骨矿物质密度从95.2±5.9增加至120.0±6.1mg/cm³羟基磷灰石（平均值±标准误）。长期睾酮治疗使所有72例性腺功能减退男性的骨矿物质密度维持在年龄相关的参考范围内，与性腺功能减退的类型无关。应用于阴囊的透皮睾酮贴片在使骨矿物质密度正常化方面与庚酸睾酮注射同样有效。总之，睾酮治疗可增加性腺功能减退男性的骨矿物质密度，与年龄无关。在初始骨矿物质密度较低的未治疗患者中，治疗的第一年骨矿物质密度增加最为显著。在性腺功能减退男性中，通过持续、长期的睾酮替代可使骨矿物质密度正常化并维持在正常范围内。
