Evidence for tissue selectivity of the synthetic androgen 7 alpha-methyl-19-nortestosterone in hypogonadal men.

Evidence for tissue selectivity of the synthetic androgen 7 alpha-methyl-19-nortestosterone in hypogonadal men.
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性腺功能减退男性中合成雄激素 7 α-甲基-19-去甲睾酮的组织选择性的证据。

DOI:
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发表时间:
2003
影响因子:
5.8
通讯作者:
K. Sundaram
K. Sundaram
中科院分区:
医学2区
文献类型:
--
作者:
Richard A. Anderson;A. Michael Wallace;N. Sattar;Narendar Kumar;K. Sundaram

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有效的合成雄激素7α-甲基-19-去甲睾酮(MENT)对5α-还原酶具有抵抗力,但它是芳香酶的底物。因此,它可以选择性地保留前列腺,同时支持其他雄激素依赖的组织。对16名性腺功能低下的男性进行了为期24周的醋酸酯植入剂治疗,随机分配到1或2个植入物(组I和组II,分别释放约400微克/天的植入物)。治疗期间维持血红蛋白浓度和红细胞压积。第一组的前列腺体积下降到一个很小的程度,但在第二组中没有统计学意义;两组的前列腺特异性抗原水平都显著下降。两组腰椎骨密度均降低。第一组患者的性行为和勃起功能下降,但第二组患者的性行为和勃起功能得以维持。因此,总的来说,一枚种植体似乎提供了亚生理性雄激素替代。2次植入剂量能够维持除骨量以外的大多数雄激素依赖的功能,并且有证据支持选择性保留前列腺。这些结果首次在人类体内证明了5-α-还原酶在组织中的选择性。此外,我们的数据与足够的雌激素作为男性替代疗法必需的雄激素活性谱的一部分的重要性是一致的。
The potent synthetic androgen 7 alpha-methyl-19-nortestosterone (MENT) is resistant to 5 alpha-reductase but is a substrate for aromatase. It may therefore offer selective sparing of the prostate gland while supporting other androgen-dependent tissues. MENT acetate implants were administered for 24 wk to 16 hypogonadal men, randomly allocated to 1 or 2 implants (groups I and II, respectively; releasing approximately 400 microg/d x implant). Hemoglobin concentration and hematocrit were maintained during MENT treatment. Prostate volume fell in group I and to a small, but statistically nonsignificant, degree in group II; the level of prostate-specific antigen fell significantly in both. Lumbar spine bone mineral density decreased in both groups. Sexual behavior and erectile function declined in group I, but were maintained in group II. Thus, overall, one MENT implant appeared to provide subphysiological androgen replacement. The 2-implant dose of MENT was able to maintain most androgen-dependent functions, except bone mass, and there was evidence to support selective sparing of the prostate gland. These results demonstrate for the first time in humans the selectivity of MENT in tissues dependent on 5 alpha-reductase. In addition, our data are consistent with the importance of adequate estrogenicity as part of the necessary spectrum of activity of an androgen for replacement therapy in men.
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