Testosterone Therapy in Men with Androgen Deficiency Syndromes: An Endocrine Society Clinical Practice Guideline
Testosterone Therapy in Men with Androgen Deficiency Syndromes: An Endocrine Society Clinical Practice Guideline
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DOI：
10.1210/jc.2009-2354
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发表时间：
2010-06-01
影响因子：
5.8
通讯作者：
Montori, Victor M.
中科院分区：
文献类型：
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作者：
Bhasin, Shalender;Cunningham, Glenn R.;Montori, Victor M.
目的：我们的目标是更新2006年发表的成年男性雄激素缺乏综合征的评估和治疗指南。参与者：工作组由内分泌学会临床指南小组委员会选出的一名主席、另外五名专家、一名方法学家和一名医学作家组成。该工作组没有收到企业的资金或报酬。结论：我们建议雄激素缺乏症的诊断，只有在男性一致的症状和体征，明确低血清睾酮水平。我们建议通过可靠的检测方法测量早晨总睾酮水平作为初步诊断试验。我们建议通过重复测量早晨总睾酮来确认诊断，对于一些总睾酮接近正常下限或通过测量游离或生物可利用睾酮水平怀疑SHBG异常的男性，使用经验证的检测方法。我们建议对有症状的雄激素缺乏的男性进行睾酮治疗，以诱导和维持第二性征，并改善他们的性功能，幸福感，肌肉质量和力量以及骨密度。我们建议，对于乳腺癌或前列腺癌患者，可触及的前列腺结节或硬结或前列腺特异性抗原大于4 ng/ml或前列腺癌高风险男性（如非洲裔美国人或一级亲属患有前列腺癌且未经进一步泌尿系统评估的男性）大于3 ng/ml的患者，血细胞比容大于50%，未经治疗的重度阻塞性睡眠呼吸暂停，重度下尿路症状，国际前列腺症状评分高于19，或心力衰竭控制不佳或控制不佳。当开始睾酮治疗时，我们建议在治疗期间使用任何批准的制剂，根据患者的偏好，考虑药代动力学，治疗负担和成本选择，以达到中等正常范围内的睾酮水平。接受睾酮治疗的男性应使用标准化计划进行监测。（临床内分泌代谢杂志95：2536-2559，2010）
Objective: Our objective was to update the guidelines for the evaluation and treatment of androgen deficiency syndromes in adult men published previously in 2006.Participants: The Task Force was composed of a chair, selected by the Clinical Guidelines Subcommittee of The Endocrine Society, five additional experts, a methodologist, and a medical writer. The Task Force received no corporate funding or remuneration.Conclusions: We recommend making a diagnosis of androgen deficiency only in men with consistent symptoms and signs and unequivocally low serum testosterone levels. We suggest the measurement of morning total testosterone level by a reliable assay as the initial diagnostic test. We recommend confirmation of the diagnosis by repeating the measurement of morning total testosterone and, in some men in whom total testosterone is near the lower limit of normal or in whom SHBG abnormality is suspected by measurement of free or bioavailable testosterone level, using validated assays. We recommend testosterone therapy for men with symptomatic androgen deficiency to induce and maintain secondary sex characteristics and to improve their sexual function, sense of well-being, muscle mass and strength, and bone mineral density. We recommend against starting testosterone therapy in patients with breast or prostate cancer, a palpable prostate nodule or induration or prostate-specific antigen greater than 4 ng/ml or greater than 3 ng/ml in men at high risk for prostate cancer such as African-Americans or men with first-degree relatives with prostate cancer without further urological evaluation, hematocrit greater than 50%, untreated severe obstructive sleep apnea, severe lower urinary tract symptoms with International Prostate Symptom Score above 19, or uncontrolled or poorly controlled heart failure. When testosterone therapy is instituted, we suggest aiming at achieving testosterone levels during treatment in the mid-normal range with any of the approved formulations, chosen on the basis of the patient's preference, consideration of pharmacokinetics, treatment burden, and cost. Men receiving testosterone therapy should be monitored using a standardized plan. (J Clin Endocrinol Metab 95: 2536-2559, 2010)