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首页> 外文期刊>Swiss medical weekly: official journal of the Swiss Society of Infectious Diseases, the Swiss Society of Internal Medicine, the Swiss Society of Pneumology >Testosterone treatment in the aging male: myth or reality?
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Testosterone treatment in the aging male: myth or reality?

机译：老年男性的睾丸激素治疗：神话还是现实？

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The definition of late onset hypogonadism in the aging male is controversially debated, and according to the latest literature consists of at least three especially sexual symptoms such as loss of morning erection, low sexual desire and erectile dysfunction as well as a total testosterone <8-l 1 nmol/1. Testosterone replacement therapy in the aging male has been shown to have a beneficial effect on muscle and fat mass as well as on bone mineral density, with more conflicting effects observed on muscle strength, sexual function, mood and quality of life. The prescriptions for testosterone products for the aging male increased by over 170% in the previous five years. Furthermore, there is a lot of epidemio-logical data showing an inverse relationship between testosterone levels and obesity, insulin resistance, the metabolic syndrome and type 2 diabetes mellitus. However, only few small randomised placebo-controlled studies have investigated the effect of testosterone replacement therapy on insulin resistance and HbAlc levels, with controversial results. Importantly, so far the long-term safety and efficacy of testosterone replacement therapy has not been established. Although until now no clear evidence has been found that testosterone replacement therapy has a causative role in prostate cancer or indeed in changes of the biology of the prostate, in a recent meta-analysis a 4-fold increased risk of prostate-associated event rates in testosterone treated elderly men sounds a note of caution. Also the risk for cardiovascular events is still not clear and caution is warranted especially in elderly men with cardiovascular disease and limited mobility. In ^w>, the actual available evidence of long-term risks and outcome of testosterone replacement therapy is still very limited and carefully designed placebo-controlled trials of testosterone administration to assess the risks and benefits of such a therapy are required. Until then, testosterone treatment in elderly men should be restricted to elderly men with clearly low testosterone levels in the presence of clinical symptoms, and the advantages and disadvantages need to be accurately weighted. A careful monitoring of potential side effects is necessary.
机译：关于衰老男性迟发性性腺功能减退的定义存在争议，根据最新文献，至少包括三种特别的性症状，如晨起勃起，性欲低下和勃起功能障碍，以及总睾丸激素<8- 1nmol / 1。已显示，在衰老的男性中，睾丸激素替代疗法对肌肉和脂肪量以及骨矿物质密度具有有益作用，并且在肌肉力量，性功能，情绪和生活质量上具有更多相互矛盾的作用。在过去的五年中，老年男性的睾丸激素产品处方增加了170％以上。此外，许多流行病学数据表明睾丸激素水平与肥胖，胰岛素抵抗，代谢综合征和2型糖尿病之间存在反比关系。然而，只有很少的随机安慰剂对照小型研究调查了睾丸激素替代疗法对胰岛素抵抗和HbAlc水平的影响，并引起了争议。重要的是，到目前为止，尚未确定睾丸激素替代疗法的长期安全性和有效性。尽管到目前为止，还没有明确的证据表明睾丸激素替代疗法对前列腺癌或确实对前列腺生物学的改变具有致病作用，但在最近的荟萃分析中，与前列腺相关的事件发生率增加了4倍。睾丸激素治疗的老年男性听起来有些谨慎。此外，心血管事件的风险仍然不明确，尤其在患有心血管疾病和行动不便的老年男性中应特别注意。在^ w>中，长期风险和睾丸激素替代疗法的结果的实际可用证据仍然非常有限，需要精心设计的安慰剂对照的睾丸激素给药试验来评估这种疗法的风险和益处。在此之前，在存在临床症状的情况下，应该将老年男性的睾丸激素治疗仅限于睾丸激素水平明显较低的老年男性，并且需要准确地权衡其优缺点。必须仔细监视潜在的副作用。

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