睾酮替代疗法对特发性低促性腺激素性性腺功能减退男性全身葡萄糖利用及其他心血管危险因素的影响。

Effect of testosterone replacement on whole body glucose utilisation and other cardiovascular risk factors in males with idiopathic hypogonadotrophic hypogonadism.

作者信息

Tripathy D, Shah P, Lakshmy R, Reddy K S

机构信息

Department of Endocrinology, All India Institute of Medical Sciences, New Delhi.

出版信息

Horm Metab Res. 1998 Oct;30(10):642-5. doi: 10.1055/s-2007-978950.

DOI:10.1055/s-2007-978950

PMID:9851674

Abstract

BACKGROUND

Excessive testosterone in males or estrogens in females could explain their differences in coronary heart disease event rates. As a contraceptive testosterone is likely to be used at large scale the role of testosterone in increasing the risks of coronary heart disease needs investigation.

AIM

To look at the role of testosterone in development of insulin resistance and other cardiovascular risk factors.

DESIGN

Prospective, before-after study on ten male subjects with idiopathic hypogonadotrophic hypogonadism pre- and post-testosterone replacement therapy; outcome measures: anthropometry, lipoprotein profile and M value (whole body glucose disposal rates on standard hyperinsulinemic euglycemic clamp; at insulin infusion rate: 40 mU x (m-2)).

RESULTS

Pre-treatment serum testosterone was 0.43 (0.515) ng x mL(-1), LH was 1.29 (0.08) IU x L(-1), and FSH was 1.54 (0.08) IU x L(-1). None had glucose intolerance. After replacement testosterone levels increased to 9.4 ng x mL(-1) (p=0.0005); weight increase of 5.0 kg (p=0.140), body mass index increase of 1.2 kg x m(-2) (p=0.28), and the change in waist to hip ratio (p=0.31) were not statistically significant. M-value (mg x kg x min(-1)) did not change after testosterone therapy (5.86 [0.72] vs 5.29 [0.82], p=0.62). Insulin levels (mU x L(-1)) achieved during the clamps were 89.5 (14.2) before and 146 (32.2) after androgen therapy (p=0.127). There was no change in glucose area under curve (mg x min x dL(-1)) (14406 [502.2] vs 12557 [826.5], p=0.312). On testosterone replacement therapy total and LDL cholesterol levels (mg x dL(-1)) declined (122.5 [13.4] vs 91.6 [5.0], p=0.04; 65.9 [9.9] vs 39.4 [7.3], p=0.05); Ratio of total cholesterol to HDL ratio also decreased significantly (p=0.05). Changes of serum triglycerides (p=0.25) and HDL cholesterol (p=0.19) did not attain statistical significance.

CONCLUSIONS

Insulin sensitivity does not decrease on testosterone replacement therapy of male subjects with idiopathic hypogonadotrophic hypogonadism. Testosterone replacement was associated with decrease in other cardiovascular risk factors.

摘要

背景

男性体内睾酮过多或女性体内雌激素过多可能解释了他们冠心病发病率的差异。作为一种避孕药，睾酮可能会被大规模使用，因此需要研究睾酮在增加冠心病风险方面的作用。

目的

研究睾酮在胰岛素抵抗及其他心血管危险因素发展过程中的作用。

设计

对10名患有特发性低促性腺激素性性腺功能减退的男性受试者在睾酮替代治疗前后进行前瞻性前后对照研究；观察指标：人体测量学指标、脂蛋白谱和M值（标准高胰岛素正常血糖钳夹试验中的全身葡萄糖处置率；胰岛素输注速率：40 mU×(m⁻²)）。

结果

治疗前血清睾酮水平为0.43（0.515）ng×mL⁻¹，促黄体生成素（LH）为1.29（0.08）IU×L⁻¹，促卵泡生成素（FSH）为1.54（0.08）IU×L⁻¹。无人有糖耐量异常。替代治疗后睾酮水平升至9.4 ng×mL⁻¹（p = 0.0005）；体重增加5.0 kg（p = 0.140），体重指数增加1.2 kg×m⁻²（p = 0.28），腰臀比变化（p = 0.31）无统计学意义。睾酮治疗后M值（mg×kg×min⁻¹）未改变（5.86 [0.72] 对比5.29 [0.82]，p = 0.62）。钳夹试验期间达到的胰岛素水平（mU×L⁻¹）治疗前为89.5（14.2），雄激素治疗后为146（32.2）（p = 0.127）。曲线下葡萄糖面积（mg×min×dL⁻¹）无变化（14406 [502.2] 对比12557 [826.5]，p = 0.312）。在睾酮替代治疗中，总胆固醇和低密度脂蛋白胆固醇水平（mg×dL⁻¹）下降（122.5 [13.4] 对比91.6 [5.