老年男性血清睾酮对代谢综合征各组分的影响

目的 探讨老年男性中血清睾酮对代谢综合征各相关组分的影响.方法 研究对象为48例老年男性,测定身高、体重、体质指数、腰围、血糖、血胰岛素、血脂以及血清睾酮浓度,并用稳态公式（HOMA）计算胰岛素抵抗（HOMA-IR）,分析血清睾酮与代谢综合征（MS）各组分的关系.结果 在老年男性中,随着MS组分数目增多,睾酮水平逐渐下降（P＜0.05）.相关分析显示睾酮浓度和体质指数、腰围、空腹血糖、空腹胰岛素、HOMA-IR呈负相关,与胆固醇、甘油三酯、高密度脂蛋白及血压的相关性不明显.结论 老年男性血清睾酮浓度与肥胖及胰岛素抵抗有密切关系,呈显著负相关.     

中老年男性勃起功能障碍与代谢综合征关联性分析

目的:探讨中老年男性勃起功能障碍(erectile dysfunction,ED)与代谢综合征(metabolic syndrome,MS)及血清睾酮(testosterone,T)之间的相关性,并分析影响ED发生的危险因素。方法:连续收集150例2017年5月～2020年5月确诊ED的门诊男性患者与150例性生活正常体检男性的一般情况、体格检查指标、代谢综合征相关生化指标、勃起硬度分级(erectile Hardness Score,EHS)及国际勃起功能5项评分(international index of erectile function 5,IIEF-5)。对比ED组与非ED组、ED并发MS组与未并发MS组各项指标差异及相关性。结果:ED组MS患病率明显高于非ED组(40.7%vs. 12.7%,P0.01)。两者在中心型肥胖指标(体重、腰围、BMI)、甘油三酯(TG)、空腹血糖(FBG)、血清睾酮(T)、舒张压(DBP)、高密度脂蛋白(HDL)差异明显(P≤0.01)。其次,ED并发MS组在EHS、IIEF-5评分上表现均差于未并发MS组(P0.01)。多元Logistic回归分析显示FBG、TG及T水平与ED发生密切相关(P0.01)。结论:ED患者中MS患病率较正常人群明显升高,ED并发MS患者病情严重程度差于未并发MS患者,MS指标中空腹血糖、甘油三酯及睾酮可能构成ED发生的主要危险因素。     

男性更年期与代谢综合征

男性更年期是人体由成熟走向衰老的过渡阶段,多数男性是在不知不觉中度过的,可以没有任何临床症状,部分中老年男性则出现与女性更年期综合征相似的临床症状和体征,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[1].     

评估勃起功能障碍男性患者的女性伴侣的性功能：对男性性功能障碍的治疗可以改善女性伴侣的性功能吗？

勃起功能障碍（ED）既影响患者也影响其女性伴侣对性生活的满意度，对ED的治疗，比如口服万艾可，能明显提高患者的满意度，而治疗是否也能提高女性伴侣对性生活的满意度呢？Cayan S等的研究对此作出了回答。研究者将87名妇女按她们的性伴侣是否有ED分为2组。男性ED患者中，30例分别行阴茎假体治疗（17例）或口服枸橼酸西地那非治疗（13例）。     

美国男性性功能障碍的研究现状

男性性功能障碍在美国也是一个较为严重的问题.1992年底的阳萎专题学术会议和1993年5月的全美泌尿外科年会对此均有深入的探讨,现将其介绍如下.1定义阳萎的定义不够明确,现在多用勃起功能障碍(Erectile dysfunction)来专指男子不具有足够的阴茎勃起以完成全部性过程所需要的能力.但此定义仍不够简明,缺乏统一的指标来判断病情及治疗效果.     

睾酮与代谢综合征

代谢综合征具有多种成分如胰岛素抵抗、糖耐量减低、血脂异常、高血压、中心性肥胖、微量蛋白尿、高尿酸血症等.低血清睾酮水平是糖尿病、动脉粥样硬化、心血管疾病的独立危险因素,与代谢综合征的发生密切相关.血清睾酮水平能预测代谢综合征的发生风险.睾酮补充治疗能延缓代谢综合征相关疾病的发展.     

减重与代谢手术对肥胖相关性功能障碍的作用

<正>随着生活方式的改变,全球肥胖率稳步上升^[1]。肥胖不但与糖尿病、高血压和冠心病等多种慢性病风险有关,还会导致或加重性功能障碍^[2]。尤其在寻求减重与代谢手术(以下简称为“减重手术”)的病人中,性功能障碍的患病率更高^[3]。减重手术作为治疗肥胖、2型糖尿病和代谢综合征等有效手段,对肥胖相关性功能障碍也有积极作用。     

154例中青年男性器质性勃起功能障碍患者与代谢综合征关联分析

目的:探讨中青年男性勃起功能障碍(erectile dysfunction,ED)与代谢综合征(metabolic syndrome,MS)及睾酮水平的相关性。方法:2012年2月至2014年1月,调查门诊154例20~59岁男性器质性ED患者与103例性生活正常男性的一般情况、腰围、血压、空腹血糖、总甘油三酯、高密度脂蛋白、血清总睾酮、国际勃起功能评分5项以及勃起功能指标,比较ED组与非ED组,以及ED患者中MS者与非MS者各项指标差别。结果:中青年ED组MS患病率显著高于非ED组MS患病率(P0.05),ED组与非ED组腹围、血压、腹围、空腹血糖、高密度脂蛋白及总睾酮均有有显著性差异(P0.05)。ED组中MS者与非MS者勃起功能各项指标及总睾酮有显著性差异(P0.05)。多元logistic回归分析MS各项指标及总睾酮与ED相关性分析,发现腰围与ED密切相关(P0.01)。结论:中青年ED患者并发MS患病率较正常人群明显增高,ED患者中并发MS者睾酮水平较低、勃起功能较差。中心性肥胖与中青年ED密切相关。     

小剂量生长激素补充对中老年男性性功能障碍患者的影响

目的 探讨小剂量生长激素补充对中老年男性性功能障碍患者的疗效和安全性。方法 30例42-77岁有性功能障碍、血睾酮水平正常的中老年男性随机分成A、B两组。A组病人按0.04U/Kg/次,每周3次,皮下注射rhGH,连续用药3个月;B组病人先给予安慰剂1个月,然后再按A组给药方案应用rhGH 3个月。记录治疗前、后各项有关指标。结果 A、B两组应用rhGH后,每月晨间勃起次数由10.25.3次增加到19.44.8次(P<0.01);成功阴道插入次数由1.61.1次增加到3.82.2次(P<0.01);男性更年期症状总评分及性功能症状评分显著下降;IIEF-5评分显著上升;而B组患者在应用安慰剂的第1个月,各项指标均无明显变化。结论 小剂量生长激素补充可使部分中老年男性性功能显著改善,无明显副作用,但由于其是一种促进全身代谢的激素,使用仍应谨慎。     

Effects of testosterone replacement therapy on metabolic syndrome among Japanese hypogonadal men: A subanalysis of a prospective randomised controlled trial (EARTH study)

We investigated the effects of testosterone replacement therapy (TRT) on metabolic factors among hypogonadal men with a metabolic syndrome. From the study population of the EARTH study, which was a randomised controlled study in Japan, 65 hypogonadal patients with a metabolic syndrome, comprising the TRT group (n = 32) and controls (n = 33), were included in this study analysis. The TRT group was administered 250 mg of testosterone enanthate as an intramuscular injection every 4 weeks for 12 months. Waist circumference, body mass index, body fat volume and blood pressure were measured in all patients at baseline and at 12 months. In addition, blood biochemical data, including total cholesterol, triglyceride (TG), HDL cholesterol, fasting plasma glucose (FPG) and haemoglobin A1c (HbA1c) levels, were also evaluated. Changes in these categories from baseline to 12 months were compared between the TRT and control groups, with significant differences observed in waist circumference, body fat percentage, FPG, TG and HbA1c levels. No significant differences were observed in other parameters. TRT for 1 year was associated with improvements in some metabolic factors among Japanese men with hypogonadism and metabolic syndrome.     

Hypogonadism and metabolic syndrome: implications for testosterone therapy

PURPOSE: Metabolic syndrome, characterized by central obesity, insulin resistance, dyslipidemia and hypertension, is highly prevalent in the United States. When left untreated, it significantly increases the risk of diabetes mellitus and cardiovascular disease. It has been suggested that hypogonadism may be an additional component of metabolic syndrome. This has potential implications for the treatment of metabolic syndrome with testosterone. We reviewed the available literature on metabolic syndrome and hypogonadism with a particular focus on testosterone therapy. MATERIALS AND METHODS: A comprehensive MEDLINE review of the world literature from 1988 to 2004 on hypogonadism, testosterone and metabolic syndrome was performed. RESULTS: Observational data suggest that metabolic syndrome is strongly associated with hypogonadism in men. Multiple interventional studies have shown that exogenous testosterone has a favorable impact on body mass, insulin secretion and sensitivity, lipid profile and blood pressure, which are the parameters most often disturbed in metabolic syndrome. CONCLUSIONS: Hypogonadism is likely a fundamental component of metabolic syndrome. Testosterone therapy may not only treat hypogonadism, but may also have tremendous potential to slow or halt the progression from metabolic syndrome to overt diabetes or cardiovascular disease via beneficial effects on insulin regulation, lipid profile and blood pressure. Furthermore, the use of testosterone to treat metabolic syndrome may also lead to the prevention of urological complications commonly associated with these chronic disease states, such as neurogenic bladder and erectile dysfunction. Physicians must be mindful to evaluate hypogonadism in all men diagnosed with metabolic syndrome as well as metabolic syndrome in all men diagnosed with hypogonadism. Future research in the form of randomized clinical trials should focus on further defining the role of testosterone for metabolic syndrome.     

Low testosterone levels and unimpaired melatonin secretion in young males with metabolic syndrome

The interrelations between testosterone, insulin and melatonin levels in males with metabolic syndrome (MS) are still not clarified, especially in young age groups. The aim of the present study was to compare the testosterone serum levels in young men with MS to those in healthy controls, and to determine the possible changes in their melatonin rhythm, as well as the relation between melatonin, insulin and lipid profile. Fasting insulin and testosterone concentrations were measured in 10 healthy nonobese and 10 MS patients. Blood samples for melatonin, insulin and luteinizing hormone (LH) were collected at 19.00, 03.00 and 11.00 hours. A significant difference was found between the testosterone levels in controls and patients. Luteinizing hormone levels in both groups were similar, however, higher night LH levels in MS patients were observed. No changes in the melatonin concentrations of the two groups were found. In conclusion, total testosterone levels were significantly lower in young men with MS compared with healthy age-matched controls. Mild hypoandrogenia in hyperinsulinaemic patients was not related with changes in their melatonin levels. No alterations in the endogenous melatonin rhythm of the MS patients were found.     

Altered melatonin secretion in hypogonadal men: clinical evidence

The pineal gland, through the rhythmic production of melatonin, seems to play an important role in the control of the reproductive function of many vertebrate species. In contrast, the effects of the pineal gland in humans and the relationship between gonadotropins and melatonin secretion are not yet clarified. On the basis of these considerations, the aim of the present study was to clarify whether melatonin serum concentrations were altered in males with different hypothalamo-pituitary-gonadal disturbances, in comparison to normal individuals. We have studied 36 individuals divided into three groups according to their gonadotropin status: normals, hypogonadotropic hypogonadism and hypergonadotropic hypogonadism. They were submitted to blood sample withdrawal at 03.00, 11.00 and 19.00 h for melatonin determination according to a radioimmunological method, without extraction of the sample. The results obtained in the present study suggest the existence of an interaction between the pituitary and the pineal gland. In fact, in the case of hypersecretion of gonadotropins, nocturnal melatonin release is reduced, while night melatonin secretion is increased in the opposite situation (hypogonadotropic hypogonadism). Both these endocrine pathologies are characterized by a reduced sexual steroid secretion; for that reason, this reduction cannot be regarded as responsible for the two opposite dysfunctions of melatonin release. In conclusion, our study shows that darkness-dependent release of melatonin in males with hypogonadotropic hypogonadism is significantly higher in comparison with the healthy men, while it is significantly reduced in patients with hypergonadotropic hypogonadism. A strong significant negative correlation is also found between gonadotropins and melatonin release.     

Screening for metabolic syndrome and testosterone deficiency in patients with erectile dysfunction: results from the first UK prospective study

Study Type – Diagnostic (exploratory cohort)
Level of Evidence 2b

OBJECTIVE

To screen patients with erectile dysfunction (ED) for the presence of metabolic syndrome (MetS), testosterone deficiency and cardiovascular (CV) risk factors, in a secondary referral centre in the UK, as men with ED have a high incidence of CV risk factors that might amount to MetS, with obesity, increased risk of coronary heart disease and type II diabetes; testosterone deficiency has also been associated with both ED and MetS.

PATIENTS AND METHODS

We assessed 124 men presenting with ED between March 2007 and August 2008. Data were collected prospectively for patient demographics, risk factors associated with MetS, and hypogonadism. MetS was assessed using the National Cholesterol Education Program Adult Treatment Panel III Criteria 2005 (based on three or more of five criteria: waist circumference, high triglycerides, low levels of high‐density lipoprotein cholesterol, hypertension and impaired glucose tolerance).

RESULTS

The mean (range) age of the men was 50 (16–76) years; 50 of 124 (40%) patients had MetS and 27% had hypogonadism. The latter was also associated with a low testicular volume and decreased libido. Ninety‐seven patients (82%) were either overweight or obese, and 64 (52%) were current or ex‐smokers.

CONCLUSIONS

Our audit confirms a high incidence of MetS and hypogonadism in patients with ED in the UK. We recommend routine screening for CV risk factors, MetS and testosterone deficiency in all patients in the UK with ED.     

Effects of testosterone gel followed by parenteral testosterone undecanoate on sexual dysfunction and on features of the metabolic syndrome

The effects of administration of testosterone (T) gel, resulting in plasma T levels in the low range of reference values, followed by testosterone undecanoate (TU), producing plasma T levels in the mid-normal range, were measured in 27 hypogonadal men aged 47-74 years. T gel had positive effects on the International Index of Erectile Function, the Aging Males' Symptoms Scale and International Prostate Symptoms Score and on the metabolic syndrome. The improvement was larger when TU was administered and plasma T levels were higher. The reduction in waist circumference and plasma cholesterol were larger with TU than with T gel, while the increases in plasma high-density lipoprotein and sex hormone binding globulin (an indicator of the severity of the metabolic syndrome) were larger with TU than with T gel. Both T gel and TU appeared safe on prostate parameters. Plasma haemoglobin and haematocrit were elevated but remained in the normal range. The assumption that treatment with T is adequate when achieved plasma levels of T are within the reference range is no longer tenable. Some androgen-dependent biological functions require higher plasma T levels than others, and, moreover, these thresholds differ among men.     

Transdermal testosterone gel: pharmacokinetics, efficacy of dosing and application site in hypogonadal men

OBJECTIVE: To determine the regimen that would most effectively maintain serum testosterone concentrations in treated hypogonadal men within the normal reference range of 3-11.4 microg/L. PATIENTS AND METHODS: Eighteen men aged 24-69 years with either primary or secondary hypogonadism participated in and 16 completed a randomized, six-treatment regimen, three-period (phase), three-way matrix-type crossover study. A 1% and 2% testosterone gel (CP601, Cellegy Pharmaceuticals, Inc., San Francisco, USA) was administered either once or twice daily transdermally at different body sites to determine optimal dosing, application sites, and its pharmacokinetics and tolerability in hypogonadal men. Treatments A-F included 1 g of 1% and 2% gel that was equivalent to 10 or 20 mg of testosterone, applied once or twice daily to the skin of either the thigh or the upper arm. Six men also participated in a study of 3 g of 2% gel that was equivalent to 60 mg of testosterone applied once daily, half on each thigh. Pharmacokinetic variables were calculated for testosterone for each man in each treatment period and the results analysed by anova. RESULTS: In general the higher dose regimens produced higher serum concentrations of testosterone; the 3 g/2% dose was most successful in maintaining serum testosterone within the normal reference range. The average testosterone concentration (C(avg)) was 6.52 microg/L and all men had a C(avg) of > 3.0 microg/L. The prediction of all men achieving a C(avg) of > 3.0 microg/L was 96%. The mean minimum concentration (C(min)) was 3.83 microg/L and half the patients had a C(min) of > 3.0 microg/L. Most men had serum testosterone levels within the normal reference range throughout the 24 h, and the treatment was well tolerated. CONCLUSIONS: The 3 g/2% dose applied to the skin daily resulted in serum testosterone in the normal reference range in most hypogonadal men. Dose adjustments to either a lower or higher dose should shift serum testosterone concentration to the desired range in those who do not achieve this range with this dose.     

Effects of long-term testosterone substitutive therapy on bone mineral content in men with hypergonadotrophic hypogonadism

Hypogonadism is one of the crucial risk factors for male osteopenia and osteoporosis. There are few studies on the effects of long-term and consistently administered testosterone substitutive therapy on bone mineral density in men with gonadal androgen deficiency, and their results have been susceptible to various interpretations. The aim of our study was an evaluation of bone mineral content in 26 men, aged 18-57 years, with hypergonadotrophic hypogonadism who underwent long-lasting androgen re-placement therapy with testosterone esters (Omnadren 250), which conditioned proper psychosomatic androgenization. The control group comprised 405 healthy men, aged 20-60 years, a representative sample of the local male population. Among all examined men and in the control group, trabecular, cortical and total bone mineral content at the distal radius of the nondominant hand were assessed by peripheral quantitative computed tomography using the Stratec 960 apparatus. In 11 hypogonadal men (42.3%), the trabecular bone mineral content was found to be within normal ranges; in 15 patients (57.7%) its values were below -1 standard deviation (SD) (osteopenia). In six patients (23.1%), the cortical bone mineral content was between +1 SD and the arithmetic mean, X; in 13 examined men (50%), the cortical bone mineral content was below X and above -1 SD. Osteopenia was diagnosed in six hypogonadal males, whereas osteoporosis was found in one man (cortical bone mineral content below -2.5 SD). Only in seven of the examined men (26.9%) was the total bone mineral content found within normal ranges, whereas in 19 men (73.1%) the total bone mineral content was below -1 SD (osteopenia). Despite the testosterone replacement in hypogonadal men, the greatest reduction of bone mineral content was found in its trabecular and total values. Among all the men examined, the trabecular and total bone mineral contents were below the mean of our own reference values. The results show that long-term and consecutively administered testosterone replacement in conventional doses, despite the normalization of serum androgen levels and the promotion of proper somatic development, does not simultaneously eliminate hypogonadal osteopenia in every case. The individually differentiated response to exogenous androgens is a characteristic feature of male hypogonadism. This study emphasizes the necessity of regular measurements of bone mineral density in hypogonadal men, as the densitometric parameters should be accepted as an osteologic (and very important) marker of androgenization of the male organism.     

Late-onset hypogonadism: beyond testosterone

Late-onset hypogonadism is defined as a combination of low testosterone (T) levels and typical symptoms and signs. A major area of uncertainty is whether T concentrations are always really sufficient to fully reflect Leydig cell (dys)function. Mild testicular alteration could be diagnosed only by additional biochemical markers, such as luteinizing hormone (LH) and 25-hydroxyvitamin D levels. These markers help in identifying the so-called “subclinical” hypogonadism (normal T, high LH levels). Patients with hypogonadism have frequently low levels of 25-hydroxyvitamin D due to impairment of the hydroxylating enzyme CYP2R1 in the testis. However, no data have been published dealing with the best treatment option (cholecalciferol – the Vitamin D precursor, or calcidiol - 25-hydroxylated form of Vitamin D) in these patients. We studied 66 patients with classic hypogonadism (total T [TT] <12 nmol l⁻¹, LH ≥ 8 IU l⁻¹) (n = 26) and subclinical hypogonadism (TT ≥ 12 nmol l⁻¹, LH ≥ 8 IU l⁻¹) (n = 40) and low 25-hydroxyvitamin D (<50 nmol l⁻¹). Subjects received cholecalciferol (5000 IU per week) (n = 20) or calcidiol (4000 IU per week) (n = 46), and 25-hydroxyvitamin D and parathyroid hormone (PTH) were evaluated after 3 months of therapy. Supplementation with calcidiol significantly increased 25-hydroxyvitamin D and significantly decreased PTH levels in both groups of men with hypogonadism (primary, n = 16 and subclinical, n = 30), whereas supplementation with cholecalciferol did not modify their levels. This study shows for the first time that the administration of the 25-hydroxylated form of Vitamin D (calcidiol), and not the administration of the precursor cholecalciferol, restores 25-hydroxyvitamin D levels in subjects with hypogonadism.     

A novel testosterone gel formulation normalizes androgen levels in hypogonadal men,with improvements in body composition and sexual function

OBJECTIVE: To compare the safety and efficacy of two doses of a new testosterone gel formulation (Testim Auxilium Pharmaceuticals, Inc., Norristown, PA, USA) to a permeation-enhanced testosterone patch (Andropatch), GlaxoSmithKline, UK) for treating men with confirmed low serum testosterone levels, and associated signs and symptoms of hypogonadism. PATIENTS AND METHODS: In all, 208 men were randomized and treated at 29 centres in Denmark, Germany, Netherlands, Sweden and the UK. The men were treated for 90 days, and the pharmacokinetics and treatment effectiveness of Testim at two doses (50 and 100 mg/day, delivering a daily dose of 5 and 10 mg testosterone, respectively) and Andropatch (2 x 2.5 mg patches, each delivering 2.5 mg testosterone and containing 12.2 mg of testosterone) were compared. Pharmacokinetic profiles were obtained, body composition measured, and mood and sexual function data recorded. RESULTS: Testim produced dose-dependent improvements in all pharmacokinetic variables compared with Andropatch. The mean increases from baseline to 90 days in testosterone were 12.41, 6.54 and 3.82 nmol/L for Testim 100 and 50 mg/day and the Andropatch, respectively. Both doses of Testim significantly improved positive and negative mood over baseline; Andropatch did not. All three treatments increased lean body mass, and the higher dose of Testim produced a significant decrease in percentage body fat. At all sample times both doses of Testim significantly improved sexual performance, sexual motivation, sexual desire and spontaneous erections. Andropatch provided insignificant improvements from baseline at all sample times for sexual desire, an inconsistent improvement in sexual motivation, but no effect on spontaneous erections. These results are similar to those previously reported for testosterone replacement therapy in hypogonadal men, suggesting that normalization of serum testosterone restores sexual function. However, the present data suggest that higher serum testosterone levels may further improve sexual function. Gel treatment was well tolerated, while patch treatment produced higher rates of application-site reactions and study discontinuation. CONCLUSION: The favourable pharmacokinetic profile and treatment outcome, combined with the enhanced tolerability of Testim, suggest that this new gel formulation is a safe and effective treatment in men with low serum testosterone levels and associated signs and symptoms of hypogonadism.