McCredie R J, McCrohon J A, Turner L, Griffiths K A, Handelsman D J, Celermajer D S
Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, Sydney, Australia.
J Am Coll Cardiol. 1998 Nov;32(5):1331-5. doi: 10.1016/s0735-1097(98)00416-1.
To assess the vascular effects of high-dose androgen treatment in genetic females.
Male gender is an independent risk factor for coronary artery disease, suggesting either a protective effect of estrogens and/or a deleterious effect of androgens. We have recently demonstrated that androgen deprivation is associated with enhanced vascular reactivity in adult men, however, the effects of androgen excess on vascular function in humans has not been reported previously.
We studied vascular reactivity in two groups of genetic females: 12 female-to-male transsexuals receiving long-term high-dose androgens, and 12 healthy female control subjects, matched for age and smoking history. Using external vascular ultrasound, brachial artery diameter was measured at rest, after flow increase (leading to flow-mediated dilatation [FMD], which depends on normal endothelial function) and after sublingual nitroglycerin (NTG), an endothelium-independent dilator.
Testosterone levels were higher (15.2+/-8.7 vs. 1.9+/-1.3 mmol/L, p < 0.001) and high-density lipoprotein cholesterol levels were lower (1.2+/-0.2 vs. 1.6+/-0.4 mmol/L, p=0.02) in the transsexuals compared with the control subjects. In each group, nine of 12 subjects were current or ex-smokers, leading to impaired FMD in both groups (5.1+/-3.7% in the transsexuals vs. 6.9+/-4.1% in controls, p=0.28). The NTG response was significantly decreased in the transsexuals (15.9+/-4.9% vs. 22+/-5.8% in controls, p=0.01), independent of the effects of age, cholesterol or vessel size.
Long-term treatment with high-dose androgens is associated with impaired vascular reactivity in genetic females, consistent with a deleterious effect of androgen excess on arterial physiology.
评估高剂量雄激素治疗对遗传女性血管的影响。
男性是冠状动脉疾病的独立危险因素，提示雌激素具有保护作用和/或雄激素具有有害作用。我们最近证明，雄激素剥夺与成年男性血管反应性增强有关，然而，此前尚未报道雄激素过量对人类血管功能的影响。
我们研究了两组遗传女性的血管反应性：12名接受长期高剂量雄激素治疗的女变男变性者，以及12名年龄和吸烟史相匹配的健康女性对照者。使用外部血管超声，在静息状态下、血流增加后（导致血流介导的血管舒张[FMD]，这取决于正常的内皮功能）以及舌下含服硝酸甘油（NTG，一种不依赖内皮的血管扩张剂）后测量肱动脉直径。
与对照者相比，变性者的睾酮水平更高（15.2±8.7 vs. 1.9±1.3 mmol/L，p<0.001），高密度脂蛋白胆固醇水平更低（1.2±0.2 vs. 1.6±0.4 mmol/L，p=0.02）。每组中，12名受试者中有9名是当前吸烟者或既往吸烟者，导致两组的FMD均受损（变性者为5.1±3.7%，对照者为6.9±4.1%，p=0.28）。变性者的NTG反应显著降低（15.9±4.9% vs. 对照者为22±5.8%，p=0.01），与年龄、胆固醇或血管大小的影响无关。
高剂量雄激素长期治疗与遗传女性血管反应性受损有关，这与雄激素过量对动脉生理的有害作用一致。
