Sarrel P M
Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut 06510, USA.
Semin Reprod Endocrinol. 1998;16(2):121-8. doi: 10.1055/s-2007-1016262.
A review of the literature of androgen actions affecting the circulatory system indicates early enthusiasm for use of testosterone in cardiac patients, subsequent disenchantment with androgens due to negative effects on lipid metabolism, and recent renewed interest as new technologies and understandings of the cardio-protective effects of estrogens has led to re-examination of the beneficial and adverse effects of androgens. Ovarian steroids, including androgens, have effects on lipid metabolism in the liver and direct effects in the arterial wall, which influence the development and progress of atherosclerosis. Androgens lower total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides but also decrease high-density lipoprotein (HDL) cholesterol levels. Androgen arterial-wall effects help maintain the mechanisms involved in vasodilation. Androgens alone appear to promote atherosclerosis but when administered with estrogens have the opposite effect in the arterial wall. Recognition of the cellular actions of androgens and the decrease in androgen production as women age after the menopause has led to increased use of androgen replacement therapy for postmenopausal women. Preliminary clinical findings in women using postmenopausal estrogen/androgen treatment indicate a good safety profile. However, in comparison to the many years and experience in evaluating the effects of estrogens, studies of androgen effects must be considered to be at a preliminary stage.
一篇关于雄激素对循环系统作用的文献综述表明，早期人们热衷于在心脏病患者中使用睾酮，随后由于其对脂质代谢的负面影响而对雄激素不再青睐，而随着新技术以及对雌激素心脏保护作用的新认识，最近又重新引发了对雄激素利弊的审视。包括雄激素在内的卵巢类固醇对肝脏脂质代谢有影响，并对动脉壁有直接作用，从而影响动脉粥样硬化的发生和发展。雄激素可降低总胆固醇、低密度脂蛋白（LDL）胆固醇和甘油三酯水平，但也会降低高密度脂蛋白（HDL）胆固醇水平。雄激素对动脉壁的作用有助于维持血管舒张相关机制。单独使用雄激素似乎会促进动脉粥样硬化，但与雌激素联合使用时在动脉壁上则产生相反的效果。随着女性绝经后年龄增长，对雄激素细胞作用的认识以及雄激素分泌的减少，导致绝经后女性雄激素替代疗法的使用增加。使用绝经后雌激素/雄激素治疗的女性的初步临床研究结果表明其安全性良好。然而，与评估雌激素作用的多年经验相比，对雄激素作用的研究仍处于初步阶段。
