十一酸睾酮与佳蓉片联合治疗PADAM的疗效观察

随着我国人口逐渐进入老年社会，中老年男子部分雄激素缺乏综合征(PADAM)的问题也逐渐引起人们的重视。据有关资料统计PADAM多发生于40岁以上男子，并随年龄增加而上升。日前治疗PADAM的药物主要是十一酸睾酮替代治疗。我所自l997年2月至今对男科门诊67例PADAM患者使用十一酸睾酮作为替代治疗，同时联合佳蓉片作为辅助治疗，结果报告如下。     

血清游离睾酮在勃起功能障碍患者中检测价值的初步探讨

目的:通过观察勃起功能障碍(ED)患者中血清计算游离睾酮(cFT)、睾酮分泌指数(TSI)及游离睾酮指数(FTI)的变化情况,探讨cFT、TSI、FTI在ED伴雄激素缺乏诊断中的价值。方法:详细询问病史,填写国际勃起功能指数问卷(IIEF-5),完成夜间阴茎勃起功能检测(NPT),根据病史及NPT检查结果纳入实验组及对照组,检测150例NPT结果异常以"ED"为主诉的ED患者及25例NPT结果正常的健康婚检者中血清总睾酮(TT)、黄体生成素(LH)、性激素结合球蛋白(SHBG)和血清白蛋白(ALB),通过公式计算cFT、生物可利用睾酮(Bio-T)、TSI、FTI。以cFT≤0.3 nmol/L、TSI≤2.8、FTI≤0.4为参考截点值,以TT≤11.5 nmol/L为诊断雄激素缺乏的标准,计算出cFT、TSI、FTI的漏诊率、误诊率及符合率。结果:以TT≤11.5 nmol/L为评估标准,诊断20~40岁ED患者雄激素缺乏的符合率分别为cFT 90.8%、TSI 85.8%、FTI 80.8%;诊断20~40岁ED患者雄激素缺乏的漏诊率分别为cFT 4.0%、TSI 33.3%、FTI 44.0%;诊断20~40岁ED患者雄激素缺乏的误诊率分别为cFT 10.5%、TSI9.4%、FTI 12.6%。Kappa值分别为:cFT 0.755、TSI 0.564、FTI 0.427,P均0.05。TT在不同年龄组ED患者中随年龄下降但无统计学差异,cFT、Bio-T、TSI、FTI在不同年龄组ED患者中随年龄下降且具有统计学差异;20~40岁ED患者血清TT、cFT、Bio-T、TSI、FTI在不同IIEF评分组的差别无统计学差异。结论:cFT对20~40岁ED患者伴有雄激素缺乏的检测价值优于TT、TSI及FTI。     

仪征市282例中老年男性PADAM和ED发病情况调查

目的研究本市中老年男性部分睾酮缺乏（PADAM）和勃起功能障碍（ED）的发生情况及相关影响因素。方法282例46-69周岁男性，按年龄分为3组，采用国际勃起功能指数（IIEF-5）和PADAM症状评分表进行问卷调查，测定血清睾酮（T）、游离睾酮（FT）。数据用SPSS软件包处理。结果3个年龄组之间T均数无明显差异（P〉0．05），而FT均数有非常显著性差异（P〈0．005）；ED、PADAM发病率有非常显著性差异（P〈0．001，P〈0．005）；PADAM组ED发病率高于对照组（P〈0.005）。结论中老年男性随着年龄的增长血清T变化不明显，FT下降明显，ED和PADAM发病率均明显升高，PADAM的发病率与FT下降关系密切，中老年男性ED的发病与年龄、内分泌关系密切。     

慢性前列腺炎合并抑郁及睾酮低下患者的临床观察及处理

目的探讨慢性前列腺炎（CP）合并抑郁及睾酮低下患者的治疗对策，分析CP患者精神心理状况与睾酮水平的关系。方法采用NIH—CPSI评分表、Zung焦虑量表（SAS）、抑郁量表（SDS）及PADAM评分表对106例CP患者进行慢性前列腺炎症状、精神心理状况和睾酮缺乏症状评估，测定其血清总睾酮和游离睾酮水平，并给予睾酮补充治疗。结果睾酮补充治疗可明显降低CP患者NIH-CPSI、SAS、SDS及PADAM评分分值，患者的自觉症状、性功能状况及与社会的融合性也明显提高。结论CP患者的精神心理状况与睾酮缺乏互为因果，睾酮补充治疗可明显改善患者的自觉症状和精神心理状况。     

游离睾酮指数与原因不明复发性流产相关性探讨

目的 探讨游离睾酮指数(FTI)与原因不明复发性流产(RSA)关系. 方法 选择2008年6月至2010年11月在我院生殖医学科就诊的原因不明RSA患者86例作为观察组,同期就诊于我院计划生育科有一次以上正常生育史的育龄女性30例作为对照组,比较两组年龄、体重指数、以及早卵泡期睾酮、FTI、黄体生成素/卵泡刺激素；分析FTI升高的RSA患者排卵情况. 结果 1.观察组血清FTI值较对照组显著升高(P＜0.01)；2.高FTI的RSA患者异常排卵发生率高. 结论 FTI升高可能与部分原因不明RSA有关.     

血清游离睾酮水平和睾酮分泌指数随年龄老化而降低

目的:调查健康成年男性血清雄激素水平随年龄老化而发生的变化,寻找部分性缺乏的雄激素界限值。方法:在北京、上海、西安和重庆四城市调查健康成年男性1 080人,年龄20岁以上,测定体重指数(BM I)、腰臀比(WHR)、黄体生成素(LH)、卵泡刺激素(FSH)、总睾酮(T)、游离睾酮(cFT)、性激素结合球蛋白(SHBG)、雌二醇(E2)、游离睾酮指数(FTI)和睾酮分泌指数(TSI)。结果:cFT、TSI和FTI随年龄的老化而逐渐下降,并与年龄和促性腺激素水平呈负相关;T没有明显变化。cFT、TSI和FTI的变化规律是一致的,40~49岁轻度下降,50岁以后下降的幅度加大,并维持相对稳定约20年,70岁以后又有进一步的下降。以20~39岁的10%位数为切点,部分性雄激素缺乏的界限值为cFT 0.3 nmol/L,TSI 2.8 nmol/IU,FTI 0.4。由cFT界限值计算的男性部分性雄激素缺乏的患病率为:40~49岁13.0%,50~59岁31.8%,60~69岁30.1%,≥70岁46.7%。结论:健康男性在40岁以后血清cFT、TSI、FTI水平随年龄老化而下降,而T没有明显变化。TSI随年龄而下降的规律与cFT非常接近,可以作为一个临床指标使用。由于TSI是根据临床常规检测的T和LH计算,因而可以免去复杂的非常规检测,降低费用,使用方便,比需要检测SHBG才能计算出来的FTI具有更大的优越性。     

中老年男子部分性雄激素缺乏综合征中医药研究进展

中老年男子部分性雄激素缺乏综合征（partial androgen deficiency in the aging male,PADAM）系指中老年男性血清中雄激素水平下降和（或）靶器官对睾酮及其活性代谢产物敏感性降低为特征的一系列临床症状,属于男性更年期范畴.随着我国人口的逐渐老龄化,本病发病逐年增多.[第一段]     

对诊断PADAM的血清游离睾酮界限值的初探

目的探寻诊断中老年男子部分雄激素缺乏综合征(PADAM)血清游离睾酮(FT)的界限值。方法根据60例45岁以上健康男性完成伊斯坦布尔症状量表(ISS)与视听性刺激(AVSS)时阴茎勃起监测结果进行分组,计算AVSS勃起功能正常组推算的游离睾酮(CFT)值的参考范围。结果AVSS勃起功能正常组CFT的中位数为0．37(0．20～0．52)nmol/L,异常组的中位数为0．25(0．12～0．40)nmol/L,z=2．25,P＜0．05,差别有显著性意义。两组性功能症状的差别也有极显著性意义(P＜0．01)。CFT的界限值是0．20nmol/L。结论研究用ISS和AVSS勃起功能正常对象的血清FT值,可为诊断PADAM建立界限值。     

中国健康男子迟发性睾丸功能减退的症状评价

目的:调查40岁以上中国健康男子出现症状与雄激素的关系,制定一份新的迟发睾丸功能减退(LOH)症状调查表。方法:设计1份18个问题的症状问卷,在北京、上海、西安和重庆4个城市调查40岁以上健康男子637人,同时测定血清总睾酮、计算的游离睾酮、睾酮分泌指数和游离睾酮指数,分析症状与上述指标的相关性。结果:12项症状与上述4项指标中的2项或以上显著相关,组成了1份新的症状筛查调查表,其灵敏度为70%,特异度为46%。结论:调查表70%的灵敏度达到了筛查的要求,特异度较低可能与个体反应差异以及其他与年龄相关激素,如GH-IGF-1、DHEA、甲状腺激素、褪黑激素和瘦素等的变化有关。     

PADAM动物模型进行同种异体睾丸间质细胞移植的研究

目的老年SD大鼠进行同种异体睾丸间质细胞移植探讨中老年男性雄激素部分缺乏症(PADAM)动物模型的可行性和疗效。方法选10只符合PADAM模型标准的老年SD大鼠作为受体，用成年SD大鼠的睾丸进行体外分离和培养，将获得的高纯度和高活力的睾丸间质细胞移植到老年SD大鼠的大腿内侧肌群内，定期检查其移植前后血清睾酮和游离睾酮的水平变化，并观察移植部位的情况。结果未应用免疫抑制剂，移植后的睾丸间质细胞保持良好的分泌功能，老年SD大鼠的血清睾酮和游离睾酮水平均显著升高，并大约于移植后的7～12d开始稳定在一定的水平，可持续27d以上。移植部位未见异常。结论睾丸问质细胞同种异体移植安全、有效、无明显排斥反应。     

江苏省3551例中老年男性健康调查

目的:了解我省中老年男性健康的基本情况。方法:对苏南、苏北、苏中随机收集3551例46~69岁的男性进行常规体检;按照勃起功能国际指数(IIEF-5)、老年男性雄激素部分缺乏(PADAM)自我评估表等进行询问。实验室检测肝肾功能和血糖、血脂指标;用放射免疫法测定血清睾酮和游离睾酮;B超检查前列腺体积及残余尿情况。结果:各年龄组B超检查的前列腺体积有明显差异(P<0.05)。各年龄组之间睾酮的差异无显著性(P>0.05),而游离睾酮随着年龄的增加而降低,有明显差异,在有更年期症状者中随着年龄的增加下降更为明显(P<0.05)。勃起功能障碍(ED)和PADAM的发病率与年龄的增加显著相关(P<0.001)。结论:男性在中老年期随着年龄的增加,体能、性功能水平下降,前列腺体积增大,ED、PADAM发病率明显增加。     

Bioavailable Testosterone With Age and Erectile Dysfunction

PurposeSymptoms of partial androgen deficiency of the aging male (PADAM), such as sexual dysfunction and depression, are receiving increased attention. Currently bioavailable testosterone (BT) is considered the most reliable marker for establishing the presence of hypogonadism. We clarified the relationship between BT and other hormones with respect to patient age and PADAM symptoms.Materials and MethodsA total of 130 patients who visited our special clinics for sexual function were included in this study. Endocrinological profiles were evaluated as appropriate, and sexual dysfunction and depression as symptoms of PADAM were assessed by a self-reported questionnaire. The relationship between age and several measures of testosterone, between BT and other hormonal measures, and between BT and PADAM symptoms were analyzed.ResultsAlthough serum total testosterone did not decrease with age, sex hormone binding globulin increased significantly. BT and free testosterone decreased significantly, and total and free testosterone correlated significantly with BT. The International Index of Erectile Function-5 score for erectile function increased significantly with increases in BT. However, the relationship between the depression score and BT was not significant.ConclusionsWe consider that BT is a useful marker for diagnosing and treating patients with PADAM because BT correlates significantly with age and International Index of Erectile Function-5 scores. We emphasize that measuring serum testosterone is necessary in aging males.     

The Aging Male's Symptoms (AMS) scale in Japanese men attending an infertility clinic

There is a gradual decline in testosterone and free testosterone with age. Physical and psychological changes can occur due to this decline of androgens--a syndrome known as "partial androgen decline in the aging male" (PADAM). Male infertility and erectile dysfunction (ED) can also be caused by androgen deficiency. Thus, male infertility, ED and PADAM are interrelated. We evaluated the prevalence of PADAM symptoms in 215 infertile patients in an infertility clinic using the Aging Males Symptom (AMS) scale. Results of the evaluation of 301 men, (30-39 years old) using the same scale, who were part of a multiphasic health screening program, served as controls. The total score of the infertile patients was lower than that of the controls. Especially, the scores of the psychological and somatic subscales were significantly lower in infertile patients (P=0.009, P=0.012, respectively). Thirty three (15.3%) of the 215 infertile patients had ED. Although the score of sexual subscale was higher in the ED patients than in the controls, the scores of the psychological and somatic subscales were not significantly different from those in the controls. In conclusion, PADAM symptoms in Japanese infertile patients were not severe. Moreover, general function was better preserved in the infertile patients than in the controls. The psychological and somatic functions of ED patients were also well preserved.     

Comparative study on evaluation methods for serum testosterone level for PADAM diagnosis

The International Society for the Study of the Aging Male (ISSAM) recommends that a diagnosis be based on a patient's total testosterone (TT), calculated free testosterone (cFT), or calculated bioavailable testosterone (cBT) for partial androgen deficiency of the aging male (PADAM). The purpose of this study was to confirm whether hypogonadism of patients with PADAM is related to symptoms and clarify which criteria of testosterone recommended by ISSAM is suitable for Japanese patients. A total of 90 patients with PADAM symptoms were included in this study. Endocrinologic profiles were reviewed as appropriate, and PADAM symptoms were judged by means of several questionnaires. Laboratory values and symptoms were compared between patients with and without hypogonadism. Even when any criterion of testosterone was used for diagnosis of hypogonadism, AMS (total and subscales), IIEF-5, or SDS scores of PADAM symptoms did not differ significantly between patients classified as having and not having hypogonadism. No other endocrinologic variables than testosterone differed significantly between them, either. PADAM symptoms are not related to testosterone level and it is still obscure whether ISSAM's criterion can be adopted for Japanese patients with PADAM. Other pathology needs to be addressed for evaluation and diagnosis of PADAM in Japan.     

微营养素对中老年男性部分雄激素缺乏综合征的作用研究

随着我国人口老龄化进程的加快,中老年人口的增加以及生活水平的提高,我国已进入老龄社会,对中老年男性健康和生活质量问题的研究已经逐渐受到重视。中老年男性部分雄激素缺乏综合征(PADAM)作为影响中老年男性健康的一种综合征,目前国内外多采用睾酮补充治疗,但是雄激素补充治疗引起的红细胞增多、前列腺增生以及前列腺癌的潜在影响也引起人们的密切关注,影响了雄激素补充治疗的临床应用。一些研究发现,许多营养素与人体的生殖功能、精子发生、雄激素合成与分泌都有一定的关系,尤其是维生素A、维生素E、微量元素锌和硒。本文主要从微营养素对PADAM的作用方面进行综述。     

Low body mass index and declining sex steroids explain most age-related bone loss in Brazilian men

Summary  Osteoporosis in men is underestimated, but our data point to an increasing prevalence rate in those over 70 years old with body mass index (BMI) <25 kg/m², bioavailable testosterone <2.7 nmol/L, bioavailable estradiol <40 pmol/L, and high bone turnover, defined in this study as serum carboxyterminal cross-linked telopeptide of type I collagen (ICTP) >4.3 μg/L. Introduction  The association of sex steroids and osteoporosis was evaluated in 104 men, aged 50–93 years old. Methods  Bone mineral density (BMD), bone turnover (ICTP), testosterone (T), and estradiol (E₂) were measured; free and bioavailable hormones (free testosterone index [FTI], BioT, free estradiol index [FEI], and BioE₂) were calculated from T, E₂, sex hormone-binding globulin (SHBG), and albumin. Nonparametric analysis and Poisson regression models were used. Results  Significant increases in SHBG and ICTP and decreases in femoral neck BMD, FTI, FEI, BioT, and BioE₂ were observed with each additional decade of age. Femoral neck BMD was inversely correlated with ICTP, and both were significantly associated with SHBG, FTI, BioT, FEI, and BioE. There was a direct and graded association between age and osteoporosis prevalence rate (OP PR; p = 0.028). Compared to participants less than 70 years old, the crude OP PR of those 80 years and older was 3.2 (95%CI = 1.4–7.3). Adjusting sequentially for BMI and bioavailable sex hormones attenuated the association between age and osteoporosis prevalence by 55% and 77%, respectively. Conclusion  Our data support the view that low BMI and declining sex steroids explain most of the association between aging, increased bone turnover, and osteoporosis in men.     

Fertility and sexual life of men after their forties and in older age

Owing to the demographic development, the aging male will require more consideration in future. In contrast to a rapid decline of estradiol during menopause in women, the process of aging in the male is retarded and subject to high individual variations. Impairment of spermatogenesis is observed as a continuous process occurring over decades. However, only about 50% of men in their eighties show complete loss of fertility. In principle, spermatogenesis may be retained well into senescence. Of importance for the individual health condition is the fact that the number of Leydig cells declines with advancing age. Thus, altered sex hormone concentrations in aging men result from both functional disturbances and a gradual reduction in Leydig cells. Furthermore, an impaired feed-back mechanism of the pituitary-gonadal axis occurs, with disappearance of the circadian testosterone (T) rhythm. LH and FSH levels are increased, and a reduced bioavailability of sex hormones is observed. Lower total testosterone concentrations in men over 60 years are accompanied by clinical signs of reduced virility, such as decreased muscle mass and strength as well as reduced sexual hair growth and libido. An age-related decline in androgen secretion and plasma testosterone levels therefore suggests the use of androgen supplementation. However, there is a lack of risk-benefit long-term studies. Increased research in the male is mandatory to meet the requirements of the aging population. This should include the availability of precise epidemiological data about the frequency of partial androgen deficiency in aging males (PADAM).     

Aging male symptoms and serum testosterone levels in healthy Japanese middle-aged men

OBJECTIVE: To evaluate the usefulness of the ADAM questionnaire and aging males' symptoms' (AMS) rating scale for Japanese middle-aged men, we analyzed the results of these tests. We also examined the range of serum testosterone levels of these individuals. MATERIAL & METHODS: Answers to these tests were obtained from 187 healthy Japanese men (from 46 to 64 years old) who visited for medical check-up. Serum total (TT) and free (FT) testosterone were also examined, and calculated free (cFT) and bioavalable (cBT) testosterone levels were obtained. RESULT: According to the ADAM questionnaire, 140 (77.8%) men were judged to be PADAM. Mean AMS total, psychological, somatovegetative, and sexual symptom scores were 29.4, 7.5, 12.9, and 9.0, respectively. Although 32 (17.5%) men had more than moderate symptoms on AMS total score, 119 (65.0%) men complained of more than moderate sexual symptoms. In contrast, the testosterone levels of these people were not always low. Mean values of TT, FT, cFT, and cBT were 5.50 ng/ml, 14.7 pg/ml, 116.1 pg/ml, and 292.3 ng/dl, respectively. None of these testosterone levels was significantly correlated with age or AMS score. Only sexual symptom score among AMS subscales was significantly correlated with age. CONCLUSION: The borderlines for the ADAM questionnaire and AMS rating scale appear too stringent for healthy Japanese middle-aged men. The sexual activity of Japanese middle-aged men appears less than that of Westerners. Criteria of these tests in Japanese middle-aged men, especially sexual function, should be changed.     

Correlations of androgen deficiency with clinical symptoms in Taiwanese males

The purpose of this study was to elucidate correlations between different biochemical measurements of androgen deficiency and clinical symptoms in male residents of Taiwan. An investigation of the serum biochemical markers for androgen deficiency in 650 males, including total testosterone, calculated free testosterone, and bioavailable testosterone, was conducted. Measurements of clinical symptoms were obtained using a questionnaire of the androgen deficiency in the aging male (ADAM) by St Louis University (SLQ). Correlations among the biochemical markers, correlations of the biochemical markers and age, and relationships between the biochemical markers and the SLQ were evaluated. The sensitivity and specificity of the SLQ were determined. Bioavailable and calculated free testosterone correlated better with age than did total testosterone. Eighty percent of the men had a positive SLQ, and 20% had a negative SLQ. The percentage of positive SLQ results increased with age. No statistically significant difference was noted between the biochemical markers of bioavailable and calculated free testosterone levels and the SLQ status except for men aged over 70 years. The SLQ in this study showed an acceptable sensitivity of about 80%, but the specificity was poor (about 20%). In conclusion, bioavailable testosterone and calculated free testosterone were more-closely correlated with age and may be better biochemical markers for androgen deficiency. SLQ might not be a suitable single measurement for androgen deficiency and should be used together with biochemical markers.