睾酮替代治疗雄激素缺乏ED患者65个月1例报告及文献复习

65-month testosterone replacement therapy for androgen deficiency-induced ED:A case report and review of the literature

目的:通过对1例雄激素缺乏的ED患者行65个月的睾酮替代治疗观察,探讨长期睾酮替代治疗的可行性及雄激素缺乏ED的机制,为其合理治疗提供参考。方法:跟踪1例雄激素缺乏的ED患者应用睾酮替代治疗65个月的治疗效果、IIEF-5评分,雄激素变化,PSA、Hb及RBC变化及长期应用睾酮的不良反应监测,并结合相关文献进行分析。结果:46岁男性,IIEF评分7分,在未治疗前血清总睾酮(TT)2.79 ng/ml,反复多次应用多种PDE5抑制剂均无效,诊断为LOH,予以睾酮替代疗法,补充十一酸睾酮胶囊,开始2周80 mg,2次/日,后改为40 mg,2次/日,2个月后TT正常达3.45 ng/ml,体能、焦虑等症状明显好转,但是性功能无明显改善,予以PDE5抑制剂按需服用,感觉应用有效,IIEF评分>21分,坚持联合用药45个月后停用PDE5抑制剂,单用睾酮替代治疗18个月,阴茎勃起坚挺,性功能满意,IIEF评分>21分,定期复查性激素水平、PSA和血常规未见明显异常。结论:睾酮替代治疗可以改善PDE5抑制剂治疗雄激素缺乏的ED的效果,长期睾酮治疗雄激素缺乏症是安全、有效的。

Objective ： To explore the mechanism of erectile dysfunction （ED） with testosterone deficiency and discuss the fea- sibility of long-term testosterone replacement therapy （TRT） by observing a case of ED with testosterone deficiency treated by TRT for 65 months. Methods： We treated an ED patient with testosterone deficiency by TST for 65 months, and evaluated the therapeutic effects by analyzing his IIEF-5 score, dynamic changes in testosterone, PSA, hemoglobin and red blood cell count, and adverse events. Results： The patient was a 46-year-old man, with an IIEF-5 score of 7, baseline serum total testosterone （TT） of 2.79 ng/ml, and no response to phosphodiesterases-5 inhibitors （PDE5i）. He was diagnosed with late-onset hypogonadism （LOH） and treated by TRT： testosterone undecanoate at 80 mg bid po for the first 2 weeks and then at 40 mg bid po. Two months after medication, the TT level was increased to normal （3.45 ng/ml） , and physical fitness and anxiety symptoms were markedly improved, with no significant improvement in sexual function. Then we administered PDE5i on demand in addition, which elevated his IIEF-5 score to 〉21. The combined medication of TRT and on-demand PDESi lasted for 45 months followed by TRT alone for another 18 months. The patient was restored to normal penile erection and sexual satisfaction, with the IIEF-5 score remaining at 〉 21. Regular follow-up revealed no significant abnormalities in the testosterone level, PSA, and routine blood tests. Conclusion： TRT enhances the effect of PDESi in the treatment of androgen deficiency-induced ED, and long-term TRT is safe and effective for androgen deficiency.