Blood testosterone threshold for androgen deficiency symptoms
Blood testosterone threshold for androgen deficiency symptoms
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DOI：
10.1210/jc.2004-0143
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发表时间：
2004-08-01
影响因子：
5.8
通讯作者：
Handelsman, DJ
中科院分区：
文献类型：
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作者：
Kelleher, S;Conway, AJ;Handelsman, DJ
关于血睾酮浓度与明显雄激素缺乏症状之间的关系的系统研究很少。因为大多数睾酮制剂都是相对短期的，它们引起的血液睾酮浓度的快速变化使得很难定义任何睾酮阈值。相比之下，皮下睾酮植入物在几天到几周内提供稳定的血睾酮浓度，而在5-7个月内逐渐下降到基线水平。因此，这提供了一个机会，通过观察雄激素缺乏的男性，当他们熟悉的雄激素缺乏症状随着睾酮颗粒慢慢溶解而恢复时，确定雄激素缺乏症状的血睾酮阈值。在52名雄激素缺乏的男性中，在雄激素缺乏症状缓解时，血液总睾酮和游离睾酮浓度在个体内高度重复性(分别为F=0.8P=0.49和F=1.4，0.24)，但在男性之间有显著差异(F=167和F=138，P均为0.001)，这表明每个人对雄激素缺乏症状的睾酮阈值是一致的，这在个体之间存在显著差异。报道最多的雄激素缺乏症状是缺乏能量，缺乏动力，性欲下降。继发性性腺功能减退患者的症状阈值显著低于原发性腺功能减退或混合性性腺功能减退患者(总的9.7+/-0.5nmol/升vs.11.7+/-0.4nmol/升和10.2+/-0.3nmol/升，P=0.006；FREE，146+/-10pmol/升vs.165+/-6pmol/升和211+/-18pmol/升，P=0.002)，但不受性腺功能低下的根本原因或任何严重的特定症状的影响。尽管雄激素缺乏症状的个体阈值范围很大，但年轻男性的平均血睾酮阈值对应于优降糖参考范围的较低端。这些观察结果对制定更具体的生活质量措施以及其他潜在的雄激素缺乏状态，如慢性病和衰老的影响仍有待确定。
There are few systematic studies of the relationship between blood testosterone concentrations and the symptoms of overt androgen deficiency. Because most testosterone preparations are relatively short-term, the rapid changes in blood testosterone concentrations they cause make it difficult to define any testosterone threshold. By contrast, subdermal testosterone implants provide stable blood testosterone concentrations over days to weeks, while gradually declining to baseline over 5-7 months. Hence, this provides an opportunity to define a blood testosterone threshold for androgen deficiency symptoms by observing androgen-deficient men as their familiar androgen deficiency symptoms return as testosterone pellets slowly dissolve. Among 52 androgen-deficient men who underwent 260 implantations over 5 yr, at the time of return of androgen deficiency symptoms the blood total and free testosterone concentrations were highly reproducible within individuals (F = 0.8, P = 0.49 and F = 1.4, 0.24, respectively) but varied markedly between men (F = 167 and F = 138, both P < 0.001), indicating that each person had a consistent testosterone threshold for androgen deficiency symptoms that differed markedly between individuals. The most reported symptoms of androgen deficiency were lack of energy, lack of motivation, and reduced libido. The symptomatic threshold was significantly lower in men with secondary hypogonadism compared with men with primary or mixed hypogonadism ( total, 9.7 +/- 0.5 nmol/liter vs. 11.7 +/- 0.4 nmol/liter and 10.2 +/- 0.3 nmol/liter, P = 0.006; free, 146 +/- 10 pmol/liter vs. 165 +/- 6 pmol/liter and 211 +/- 18 pmol/liter, P = 0.002) but was not affected by the underlying cause of hypogonadism or by specific symptoms of any severity. Despite a wide range in individual thresholds for androgen deficiency symptoms, the mean blood testosterone threshold corresponded to the lower end of the eugonadal reference range for young men. The implications of these observations for the development of more specific quality-of-life measures, as well as for other potential androgen deficiency states such as chronic diseases and aging, remain to be determined.