Diagnosis and Treatment of Testosterone Deficiency: Recommendations From the Fourth International Consultation for Sexual Medicine (ICSM 2015)
Diagnosis and Treatment of Testosterone Deficiency: Recommendations From the Fourth International Consultation for Sexual Medicine (ICSM 2015)
复制标题
DOI：
10.1016/j.jsxm.2016.10.009
复制
发表时间：
2016-12-01
影响因子：
3.5
通讯作者：
Salonia, Andrea
中科院分区：
文献类型：
--
作者：
Khera, Mohit;Adaikan, Ganesh;Salonia, Andrea
简介：睾酮缺乏症（TD），也称为性腺功能减退症，是一种随着年龄增长而影响相当大比例男性的疾病。TD的诊断和管理具有挑战性，临床医生应了解有关TD诊断和管理的现有文献，并从第四届国际性医学咨询会议（ICSM）中提供临床相关建议。使用PubMed数据库进行文献检索，检索截至2016年1月发表或电子发表的英文原创和综述文章。主要结局指标：证据等级（LoE）和等级的建议是基于对文献和委员会共识的全面分析而提供的。结果：对12类TD给出了建议：定义、临床诊断、常规测量、筛选问卷、实验室诊断、TD生化诊断的阈值水平、前列腺癌、心血管疾病、生育力，睾酮（T）制剂、T疗法的替代物以及不良事件和监测。共提出了42项建议：其中16项与第三次国际社会监测会议相同，26项是第四次国际社会监测会议期间提出的新建议。这些建议中的大多数得到了第2和第3条评价重点的支持。几个关键的新建议包括以下内容：（i）TD的临床表现是由于血清雄激素浓度或活性降低而发生的，无论是否存在已确定的潜在病因[LoE = 1，等级= A];（ii）总T水平低于12 nmol/L或350 ng/dL的有症状男性应接受T治疗[LoE = 1，等级= C];（iii）基于临床表现，可以考虑在总T水平高于12 nmol/L或350 ng/dL的有症状男性中进行T治疗试验[LoE = 3，等级= C];（iv）没有令人信服的证据表明T治疗增加患前列腺癌的风险或其使用与前列腺癌进展相关[LoE = 1，等级= C];（v）证据权重表明T治疗与心血管风险增加无关[LoE = 2，Grade = B]。结论：TD是一种严重影响男性性健康的重要疾病。我们提供有关其诊断和管理的指导。接受治疗的TD男性通常会在性症状和非性健康益处方面得到解决或改善。版权所有（C）2016，国际性医学学会。爱思唯尔公司出版All rights reserved.
Introduction: Testosterone deficiency (TD), also known as hypogonadism, is a condition affecting a substantial proportion of men as they age. The diagnosis and management of TD can be challenging and clinicians should be aware of the current literature on this condition.Aim: To review the available literature concerning the diagnosis and management of TD and to provide clinically relevant recommendations from the Fourth International Consultation for Sexual Medicine (ICSM) meeting.Methods: A literature search was performed using the PubMed database for English-language original and review articles published or e-published up to January 2016.Main Outcome Measures: Levels of evidence (LoEs) and grades of recommendations are provided based on a thorough analysis of the literature and committee consensus.Results: Recommendations were given for 12 categories of TD: definition, clinical diagnosis, routine measurement, screening questionnaires, laboratory diagnosis, threshold levels for the biochemical diagnosis of TD, prostate cancer, cardiovascular disease, fertility, testosterone (T) formulations, alternatives to T therapy, and adverse events and monitoring. A total of 42 recommendations were made: of these, 16 were unchanged from the Third ICSM and 26 new recommendations were made during this Fourth ICSM. Most of these recommendations were supported by LoEs 2 and 3. Several key new recommendations include the following: (i) the clinical manifestations of TD occur as a result of decreased serum androgen concentrations or activity, regardless of whether there is an identified underlying etiology [LoE = 1, Grade = A]; (ii) symptomatic men with total T levels lower than 12 nmol/L or 350 ng/dL should be treated with T therapy [LoE = 1, Grade = C]; (iii) a trial of T therapy in symptomatic men with total T levels higher than 12 nmol/L or 350 ng/dL can be considered based on clinical presentation [LoE = 3, Grade = C]; (iv) there is no compelling evidence that T treatment increases the risk of developing prostate cancer or that its use is associated with prostate cancer progression [LoE = 1, Grade = C]; and (v) the weight of evidence indicates that T therapy is not associated with increased cardiovascular risk [LoE = 2, Grade = B].Conclusion: TD is an important condition that can profoundly affect the sexual health of men. We provide guidance regarding its diagnosis and management. Men with TD who receive treatment often experience resolution or improvement in their sexual symptoms and non-sexual health benefits. Copyright (C) 2016, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.