风险与效益:迟发型性腺功能减退症的治疗新理念

Risks and benefits: New concepts of treatment of late-onset hypogonadism

迟发型性腺功能减退症(LOH)是一种与男性年龄增长相关的临床和生物化学综合征,严重影响某些患者的生活质量。LOH的经典治疗方案是睾酮补充治疗(TST),其疗效已得到验证,但远期安全性尚需评估。随着对LOH研究的不断深入,新的治疗方案逐渐被提出,如促性腺激素及其类似物、T前体[脱氢表雄酮(DHEA)]、非芳香化雄激素[双氢睾酮(DHT)]补充治疗、雌激素拮抗剂(包括减少雌激素来源的芳香化酶抑制剂和雌激素受体阻滞剂)及中医药治疗。同时,睾丸间质干细胞移植、选择性雄激素受体调节剂(SARMs)及选择性雌激素β受体激动剂的研究,亦为LOH的治疗提供了新的思路。本文就目前LOH的治疗进展作一介绍。

Late-onset hypogonadism （LOH） is a clinical and bio-chemical syndrome associated with advancing age in males and seriously affects the quality of life of some of the patients. A classical therapeutic option for LOH is testosterone supplementary treatment （TST）. Its effectiveness has been verified, whereas its long-term safety remains to be further evaluated. With deeper insights into LOH, many new therapeutic strategies have been proposed, which include the treatments with gonadotropins, testosterone precursors （such as dehydruepiandrnsterone [ DHEA] ）, non-aromatizable androgens （such as dihydrotestosterone [DHT] ）, antiestrogens （such as aromatase inhibitors and estrogen receptor antagonists） , and Chinese medicine. Meanwhile, studies on the transplantalion of Leydig stem cells, selective androgen receptor modulators （SARMs） , and selective estrogen receptor β （ERβ） agonists have shed new light on the treatment of LOH.