雄激素补充对中老年部分睾酮缺乏综合征中伴发抑郁症的治疗观察

目的探讨中老年部分睾酮缺乏综合征(PADAM)与中老年抑郁症的关系。方法对PADAM量表测评为PADAM的病人另给予抑郁自测量表(SDS)测评,SDS评分增高者分成治疗与对照二组,治疗组给予十一酸睾酮(安特尔)胶囊口服。每2周门诊随访一次,观测抑郁症状的变化及服用后有无副作用。3个月后,予两个表复测评估。结果除PADAM症状明显缓解外,抑郁症状明显改善,全部SDS的评分均明显下降,与服用雄激素之前有明显差异。结论中老年抑郁症与PADAM明显相关,服用雄激素补充后抑郁症状明显改善。     

衰老对老年男性性腺功能的影响及其机理

在衰老过程中有相当比例的男性随着年龄的增长出现性腺功能减退的症状和体征，并伴有血清睾酮水平降低，称为老年男性雄激素缺乏(ADAM)或部分雄激素缺乏(PADAM)或男性更年期(andropause)。与腹型肥胖、血脂异常、骨质疏松、肌肉容积缩小、肌力减退、勃起功能障碍和抑郁及认知功能减退等疾病的发生与男性性腺功能减退相关。而且，睾酮补充治疗使血清睾酮水平在正常范围内，可以明显改善性激素缺乏的临床表现。因此衰老对男性性腺功能的影响及其发生机理越来越受到关注。     

安特尔、保列治治疗PADAM合并BPH 42例体会

目的：年龄和雄激素是前列腺增生的二个条件，中、老年男性部分雄激素缺乏激素补充治疗是否对前列腺肥大患者有不良影响尚无定论，本文对前列腺肥大合并部分雄激素缺乏患者的治疗方法进行了探讨。方法：对2000年7月到2002年3月在我院男科门诊就诊，确诊为前列腺肥大和部分雄激素缺乏综合征的患者给予保列治、安特尔联合治疗，并且对相关指标：游离睾酮、最大尿流率、前列腺症状积分、男子更年期症状积分、前列腺超声等进行观察。结果：治疗前后前列腺症状积分、尿流率、游离睾酮、男子更年期症状积分均有显著意义的改善，而血脂、EKG、PSA则无变化。结论：保列治、安特尔治疗PADAM合并BPH是安全、有效的。     

雄激素补充治疗男性更年期综合征的临床研究

为探讨雄激素补充治疗对男性更年期综合征的疗效,本文通过对68例诊断为男性更年期综合征病人分组,其中40例作雄激素补充治疗并对其临床症状,血睾酮水平,主观抑郁症状评分作观察,并与28例病情相同的病人予安慰剂对照.观察的病人症状改善率为74.3%;血睾酮水平3周前后分别为131.51±1912与253.78±21.45,抑郁症状评分各指标均有较大改善.作者认为雄激素补充疗法是治疗男性更年期综合征的一种有效、安全的方法.     

睾酮替代治疗雄激素缺乏ED患者65个月1例报告及文献复习

目的:通过对1例雄激素缺乏的ED患者行65个月的睾酮替代治疗观察,探讨长期睾酮替代治疗的可行性及雄激素缺乏ED的机制,为其合理治疗提供参考。方法:跟踪1例雄激素缺乏的ED患者应用睾酮替代治疗65个月的治疗效果、IIEF-5评分,雄激素变化,PSA、Hb及RBC变化及长期应用睾酮的不良反应监测,并结合相关文献进行分析。结果:46岁男性,IIEF评分7分,在未治疗前血清总睾酮(TT)2.79 ng/ml,反复多次应用多种PDE5抑制剂均无效,诊断为LOH,予以睾酮替代疗法,补充十一酸睾酮胶囊,开始2周80 mg,2次/日,后改为40 mg,2次/日,2个月后TT正常达3.45 ng/ml,体能、焦虑等症状明显好转,但是性功能无明显改善,予以PDE5抑制剂按需服用,感觉应用有效,IIEF评分21分,坚持联合用药45个月后停用PDE5抑制剂,单用睾酮替代治疗18个月,阴茎勃起坚挺,性功能满意,IIEF评分21分,定期复查性激素水平、PSA和血常规未见明显异常。结论:睾酮替代治疗可以改善PDE5抑制剂治疗雄激素缺乏的ED的效果,长期睾酮治疗雄激素缺乏症是安全、有效的。     

慢性前列腺炎合并抑郁及睾酮低下患者的临床观察及处理

目的探讨慢性前列腺炎（CP）合并抑郁及睾酮低下患者的治疗对策，分析CP患者精神心理状况与睾酮水平的关系。方法采用NIH—CPSI评分表、Zung焦虑量表（SAS）、抑郁量表（SDS）及PADAM评分表对106例CP患者进行慢性前列腺炎症状、精神心理状况和睾酮缺乏症状评估，测定其血清总睾酮和游离睾酮水平，并给予睾酮补充治疗。结果睾酮补充治疗可明显降低CP患者NIH-CPSI、SAS、SDS及PADAM评分分值，患者的自觉症状、性功能状况及与社会的融合性也明显提高。结论CP患者的精神心理状况与睾酮缺乏互为因果，睾酮补充治疗可明显改善患者的自觉症状和精神心理状况。     

雄激素部分缺乏误诊为中老年抑郁和痴呆1例

中老年男性出现一系列雄激素部分缺乏的临床症状特别容易与抑郁和痴呆相互混淆,并因此而造成误诊误治。本文报道了1例中老年男性雄激素部分缺乏综合征(PADAM)患者反复被误诊为老年抑郁和痴呆,值得引起临床关注。造成误诊误治的原因主要包括对PADAM的含义不了解、临床症状缺乏特异性、没有进行必要的专科检查和激素水平分析等。     

游离睾酮与老年男性骨质疏松的关系

雄激素是维持男性第二性征的主要激素 ,目前认为雄激素缺乏是男性骨质疏松的主要原因 ,发病高峰在 6 5岁以后 ,临床上由于老年男性睾酮水平的降低呈缓慢发展趋势 ,不象妇女有明显的绝经期变化 ,故而其骨质疏松的发生隐匿 ,症状不典型 ,易延误诊断 ,往往引起骨折才被重视。为此 ,我们观察了6 0例老年男性部分雄激素缺乏综合征 (ｐａｒｔｉａｌａｎ ｄｒｏｇｅｎｄｅｆｉｃｉｅｎｃｙｏｆｔｈｅａｇｉｎｇｍａｌｅ ,ＰＡＤＡＭ )病人游离睾酮 (ＦＴ)的水平 ,并与 5 5例年龄匹配的正常男性对照 ,探讨其与骨质疏松的关系。1　对象与方法1　研究…     

江苏省3551例中老年男性健康调查

目的:了解我省中老年男性健康的基本情况。方法:对苏南、苏北、苏中随机收集3551例46~69岁的男性进行常规体检;按照勃起功能国际指数(IIEF-5)、老年男性雄激素部分缺乏(PADAM)自我评估表等进行询问。实验室检测肝肾功能和血糖、血脂指标;用放射免疫法测定血清睾酮和游离睾酮;B超检查前列腺体积及残余尿情况。结果:各年龄组B超检查的前列腺体积有明显差异(P<0.05)。各年龄组之间睾酮的差异无显著性(P>0.05),而游离睾酮随着年龄的增加而降低,有明显差异,在有更年期症状者中随着年龄的增加下降更为明显(P<0.05)。勃起功能障碍(ED)和PADAM的发病率与年龄的增加显著相关(P<0.001)。结论:男性在中老年期随着年龄的增加,体能、性功能水平下降,前列腺体积增大,ED、PADAM发病率明显增加。     

原发性精索静脉曲张与中老年男性雄激素部分缺乏征相关性探讨

目的 探讨原发性情索静脉曲张VC与中老年男性雄激素部分缺乏症(DADAM)的关系.方法 收集40岁以上原发性精索静脉曲张146例合并PADAM86例患者的监床资料,86例患者的临床症状行PADAM量表评分和精索内静脉高位结扎,其中72例术后给予雄激素替代治疗(TST).结果 146例VC患者合并PADAM86例,发病率68.3％,具有体能血管舒缩症状者72例(83.7％),精神心理症状者68例(79.2％),性功能症状者71例(82.5％),血清睾酮(T)含量小于2.8ng/d 110例(11.6％),2.8ng/dl ～ 4ng/dl62例(72.1％).86例患者经手术加TST治疗后,临床症状评分由22(20～40),下降为10(8～10),T小于2.8ng/dl 10例和T2.8ng～ 4ng/dl的62例患者血清T含量恢复正常,晨间阴茎勃起和性活动频次增加.结论 对40岁以上已生育的VC合并PADAM的患者建议手术治疗,对于血清睾酮水平小于正常或正常偏低者给予TST.     

Analysis of clinical manifestations and endocrinological aspects of patients having PADAM-like symptoms

PURPOSE: To analyze clinical manifestations and endocrinological aspects of the patients who visited our hospital to be examined for partial androgen deficiency in the aging male (PADAM). MATERIALS AND METHODS: Two hundred forty-three patients were evaluated. History taking and questionnaires were employed for analysis of their symptoms. Serum total testosterone (T), free-T and other hormones were measured for evaluation of the androgen deficiency. RESULTS: The chief complains of the patients were categorized as psychological symptoms, somatovegatative symptoms, and sexual symptoms, accounting for 51%, 36%, and 13%, respectively. A depressed mood, hot flashes and sweating and erectile dysfunction were dominant in these symptom categories, respectively. The prevalence of the psychological symptoms and somatovegatative symptoms was relatively high in the 30-50-year-old and 60-70-year-old groups, respectively. The free-T, but not total-T, was significantly decreased with aging as measured by the RIA method. Twenty one percent of the patients showed a lower total-T level than the normal range (2.7-10.7 ng/ml). The percentage of those with a total-T level lower than 2.0 ng/dl, which is the criterion for T-replacement recommended by the American Association of Clinical Endocrinologists guidelines, was 9%. Eighty two percent and 30% of the patients had lower free-T levels than the normal range (15.2-43.5 pg/ml) and that of men in their twenties in the Canadian data (9.3-26.5 pg/ml). Depending on the criteria of androgen deficiency, not all patients had low total-T and free-T levels. CONCLUSION: Patients suspected of having PADAM present various clinical symptoms and endocrinological aspects.     

Comparative study on evaluation methods for serum testosterone level for PADAM diagnosis

The International Society for the Study of the Aging Male (ISSAM) recommends that a diagnosis be based on a patient's total testosterone (TT), calculated free testosterone (cFT), or calculated bioavailable testosterone (cBT) for partial androgen deficiency of the aging male (PADAM). The purpose of this study was to confirm whether hypogonadism of patients with PADAM is related to symptoms and clarify which criteria of testosterone recommended by ISSAM is suitable for Japanese patients. A total of 90 patients with PADAM symptoms were included in this study. Endocrinologic profiles were reviewed as appropriate, and PADAM symptoms were judged by means of several questionnaires. Laboratory values and symptoms were compared between patients with and without hypogonadism. Even when any criterion of testosterone was used for diagnosis of hypogonadism, AMS (total and subscales), IIEF-5, or SDS scores of PADAM symptoms did not differ significantly between patients classified as having and not having hypogonadism. No other endocrinologic variables than testosterone differed significantly between them, either. PADAM symptoms are not related to testosterone level and it is still obscure whether ISSAM's criterion can be adopted for Japanese patients with PADAM. Other pathology needs to be addressed for evaluation and diagnosis of PADAM in Japan.     

The Aging Male's Symptoms (AMS) scale in Japanese men attending an infertility clinic

There is a gradual decline in testosterone and free testosterone with age. Physical and psychological changes can occur due to this decline of androgens--a syndrome known as "partial androgen decline in the aging male" (PADAM). Male infertility and erectile dysfunction (ED) can also be caused by androgen deficiency. Thus, male infertility, ED and PADAM are interrelated. We evaluated the prevalence of PADAM symptoms in 215 infertile patients in an infertility clinic using the Aging Males Symptom (AMS) scale. Results of the evaluation of 301 men, (30-39 years old) using the same scale, who were part of a multiphasic health screening program, served as controls. The total score of the infertile patients was lower than that of the controls. Especially, the scores of the psychological and somatic subscales were significantly lower in infertile patients (P=0.009, P=0.012, respectively). Thirty three (15.3%) of the 215 infertile patients had ED. Although the score of sexual subscale was higher in the ED patients than in the controls, the scores of the psychological and somatic subscales were not significantly different from those in the controls. In conclusion, PADAM symptoms in Japanese infertile patients were not severe. Moreover, general function was better preserved in the infertile patients than in the controls. The psychological and somatic functions of ED patients were also well preserved.     

对诊断PADAM的游离睾酮指数的评估

目的 评价诊断中老年男子部分雄激素缺乏综合征（PADAM）的游离睾酮指数（FTI）.方法 对129例45岁以上健康男性的FTI进行年龄相关分析.以推算的游离睾酮（CFT）值为依据,对FTI进行有效性检验.结果 男子在中老年期FTI与增龄呈明显的负相关.FTI敏感性97.78%,特异性58.33%.结论 计算简单的FTI可用于PADAM病人的筛选和随访,尤其对70岁以上男子是血清FT较为有效的参数.     

PADAM aus urologischer Sicht

PADAM stands for partial androgen deficiency in the aging male, and it is currently diagnosed with a testosterone level below 3 ng/ml (300 ng/dl or 12 nmol/l), and with symptoms varying according to the individual. The symptoms are a reduction or even loss of libido, a decline in muscle mass and strength, enhancement of visceral fatty tissue-padding, dryness of the skin, apathy, tiredness and distortion of mood right up to depression, and ostalgia due to osteoporosis. Before starting any form of hormonal substitution, which is only indicated if clinical symptoms and testosterone deficiency correlate, it is absolutely essential to exclude prostate cancer by using clinical evaluation and PSA values. Close PSA monitoring is necessary during testosterone substitution. In more than 95% of all patients with erectile dysfunction, the cause is not testosterone deficiency. Even a decreased level of dehydroepiandrosterone (DHEA) in an elderly male needs no replacement. There is also no indication for estradiol therapy in men--except in the rare case of aromatase deficiency.     

微营养素对中老年男性部分雄激素缺乏综合征的作用研究

随着我国人口老龄化进程的加快,中老年人口的增加以及生活水平的提高,我国已进入老龄社会,对中老年男性健康和生活质量问题的研究已经逐渐受到重视。中老年男性部分雄激素缺乏综合征(PADAM)作为影响中老年男性健康的一种综合征,目前国内外多采用睾酮补充治疗,但是雄激素补充治疗引起的红细胞增多、前列腺增生以及前列腺癌的潜在影响也引起人们的密切关注,影响了雄激素补充治疗的临床应用。一些研究发现,许多营养素与人体的生殖功能、精子发生、雄激素合成与分泌都有一定的关系,尤其是维生素A、维生素E、微量元素锌和硒。本文主要从微营养素对PADAM的作用方面进行综述。     

Bioavailable Testosterone With Age and Erectile Dysfunction

PurposeSymptoms of partial androgen deficiency of the aging male (PADAM), such as sexual dysfunction and depression, are receiving increased attention. Currently bioavailable testosterone (BT) is considered the most reliable marker for establishing the presence of hypogonadism. We clarified the relationship between BT and other hormones with respect to patient age and PADAM symptoms.Materials and MethodsA total of 130 patients who visited our special clinics for sexual function were included in this study. Endocrinological profiles were evaluated as appropriate, and sexual dysfunction and depression as symptoms of PADAM were assessed by a self-reported questionnaire. The relationship between age and several measures of testosterone, between BT and other hormonal measures, and between BT and PADAM symptoms were analyzed.ResultsAlthough serum total testosterone did not decrease with age, sex hormone binding globulin increased significantly. BT and free testosterone decreased significantly, and total and free testosterone correlated significantly with BT. The International Index of Erectile Function-5 score for erectile function increased significantly with increases in BT. However, the relationship between the depression score and BT was not significant.ConclusionsWe consider that BT is a useful marker for diagnosing and treating patients with PADAM because BT correlates significantly with age and International Index of Erectile Function-5 scores. We emphasize that measuring serum testosterone is necessary in aging males.