男性更年期综合征的发病机制

男性更年期是人体由成熟走向衰老的过渡阶段，多数男子是在不知不觉中度过的，可以没有任何临床症状，部分中老年男子则出现与女性更年期综合征相似的临床症状和体征，可以对多器官系统的功能造成不良影响，并降低生活质量，称之为男性更年期综合征。男性更年期综合征是多病因、多因素性疾病，其中病因研究比较深入的是雄激素（包括雄激素水平和雄激素作用）的部分缺乏，有人将其称为“中老年男子雄激素部分缺乏综合征（PADAM）”。     

男性更年期综合征误诊绝育术后并发症1例报告

男性更年期综合征,又称中老年男性部分雄激素缺乏综合征(PADAM).临床上根据患者的年龄、症状、体征、病史以及必要的检查,诊断并不困难,但笔者遇1例误诊为男性绝育术后并发症近5年之久的病例,报告如下.     

睾酮补充疗法对中老年男性前列腺的影响

中老年男性部分雄激素缺乏症(partial androgen deficiency in aging male，PADAM)，又称男性更年期，是指中老年男性睾酮部分降低或靶器官对睾酮或其活性代谢产物的敏感性降低的一种临床症状。包括精神心理、生理体能、性功能、血管舒缩等四方面症状。随着我国社会老龄化的进程及人们对生活质量要求的提高，今后我们必然需要面对更多的PADAM患者。     

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。     

中老年男子部分性雄激素缺乏综合征中医药研究进展

中老年男子部分性雄激素缺乏综合征（partial androgen deficiency in the aging male,PADAM）系指中老年男性血清中雄激素水平下降和（或）靶器官对睾酮及其活性代谢产物敏感性降低为特征的一系列临床症状,属于男性更年期范畴.随着我国人口的逐渐老龄化,本病发病逐年增多.[第一段]     

中老年男性生长激素部分缺乏的研究进展

近年来的研究表明[1],随着年龄的增长,中老年男性体内的一些内分泌激素如:生长激素(GH),睾酮,褪黑素等会逐渐下降,而伴随这些激素改变的是中老年男性出现身体脂肪增加、骨质疏松症、睡眠和情绪障碍、性功能减退等,由于这些与增龄有关的身体变化和激素缺乏引起的症状和体征相似,因此人们推测中老年男性出现的一些衰退症状是由于这些激素的缺乏引起。目前有关中老年男性雄激素部分缺乏(PADAM)的报道较多,而有关生长激素部分缺乏对中老年男性影响的研究很少,对此我们作一综述。在老年动物和人类衰老过程中,机体组织合成蛋白质的能力普遍下降…     

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。     

老年男性痴呆病人雄激素补充治疗初探

目的 :探讨老年男性痴呆病人内分泌激素水平及雄激素补充治疗效果。　方法 :选择 9例没有雄激素补充治疗禁忌证且经精神科确诊为老年痴呆的男性病人 ,进行一般健康状况、精神状况、内分泌激素水平等的全面评价 ,并给予补充十一酸睾酮酯 (商品名 :安特尔 ) 12 0mg/d ,连续口服 6周 ,观察并记录治疗前后的变化。　结果 :治疗前 9例老年痴呆病人简易精神状态检查表 (MMSE)平均积分为 5 .3 3分 ,汉米尔顿抑郁量表 (HAMD)评分平均为14.5 6分 ,总体衰退量表 (GDS)平均积分为 5 .0级 ,老年男性雄激素部分缺乏 (PADAM )量表评分平均为 3 2 .5 6分 ,睾丸体积偏小 (平均体积 8.3 3ml)。补充睾酮治疗终止 1周后 ,血清总睾酮水平显著降低 (从 2 .88ng/ml降至 2 .47ng/ml,P <0 .0 5 ) ,游离睾酮水平也有一定程度的降低 ,但差别无显著性 (P >0 .0 5 )。治疗前后临床总体印象 (CGI)表明 ,2例病情无明显改变 ;7例均有不同程度改善 ,其中 3例病人明显改善 ,表现在HAMD平均积分降低 ( 10 .67分 )、PADAM量表平均评分降低 ( 2 8.11分 ) ,病人的体能症状和精神心理症状明显改善 ,血管舒缩症状改善不明显 ,而性方面的症状无改善。　结论 :老年男性痴呆病人体内雄激素水平偏低 ,并明显存在雄激素缺乏的相关症状 ,雄激素补充治?     

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。     

雄激素与男性骨质疏松症

男性也有更年期，年龄大约在40～55岁。男性更年期的发生虽然也源于雄激素下降，但与女性有所不同。男性雄激素的分泌始终没有完全停止，只是随着增龄，分泌下降而已。因而，确切的说，男性更年期应称为“部分雄激素缺乏综合征”（PADAM）。     

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.     

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.     

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.     

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.     

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.     

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.     

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。