澳科学家揭开“男性更年期”真面目

休斯敦——一项大型人群纵向研究显示，睾酮水平降低及其相关症状——即俗称的“男性更年期”——并不是男性衰老的必然结果。

在这项目前仍在进行的MAILES研究中，南澳大利亚阿德莱德大学的Gary A. Wittert博士及其同事纳入1,382例基线时平均54岁的男性社区居民，对睾酮水平随时间推移的变化趋势进行了分析。受试者均未使用已知可影响激素水平的药物。

Gary Wittert博士

研究显示，基线时受试者的平均血清总睾酮水平为16.2 nmol/L，随访5年时为15.6 nmol/L，睾酮水平基本上不受年龄影响。尽管在5年随访期间总人群的睾酮水平无显著改变，但部分受试者的睾酮水平显著降低。多因素线性回归分析显示，某些因素可明显预测睾酮水平的进行性降低，这些因素包括未婚状态、基线时和随访时抑郁、心血管疾病、肥胖，以及随访期间体重增加。

保持体重正常的受试者的睾酮水平未随时间推移而改变。体重降低者的睾酮水平轻微增加。基线时体重正常但随访期间变得肥胖的受试者的睾酮水平降低，并且黄体生成素水平未代偿性升高，提示下丘脑/垂体水平存在中枢衰竭。

在戒烟的受试者中观察到睾酮水平趋于降低。虽然这显然不应成为继续吸烟的理由，但吸烟与睾酮水平之间的这种关系值得进一步研究。

研究者表示，临床医生应当明白，睾酮水平降低并不是衰老的一个自然表现，而很可能是缘于健康相关行为或健康状况本身，尤其是慢性疾病、肥胖和抑郁。因此要预防睾酮水平降低及其相关后果，应保持良好情绪、避免肥胖及维持健康的生活方式。

该研究获澳大利亚国立卫生和医学研究委员会资助。

爱思唯尔  版权所有

By: BRUCE JANCIN, Clinical Endocrinology News Digital Network

HOUSTON – A decline in testosterone is not an inevitable result of aging in men, according to a large population-based, longitudinal study.

"There’s an often-spoken-about concept that there is a decrease in testosterone with increasing age in men. Some people have even gone so far as to talk about an ‘andropause,’ or sudden drop in testosterone at some particular critical point in time reached in middle age. But we showed there’s almost no change in testosterone with age. At baseline, the mean serum total testosterone was 16.2 nmol/L, and at 5 years of follow-up it was 15.6. So essentially there is no age effect," declared Dr. Gary A. Wittert, professor of medicine at the University of Adelaide (South Australia).

He is director of the ongoing longitudinal MAILES (Male Adelaide Inflammation Lifestyle Environment Study). For this analysis of testosterone trends over time, he reported on 1,382 community-dwelling MAILES participants who averaged 54 years of age at entry. None was on medications that were known to affect hormones.

Although there was no significant change in testosterone over the course of 5 years in the overall group, some men did experience a significant decline in levels. A multivariate linear regression analysis identified several potent predictors of a progressive fall in testosterone (unmarried status, being depressed at baseline and at follow-up, cardiovascular disease, obesity, and weight gain during follow-up).

"It is critical that doctors understand that declining testosterone levels are not a natural part of aging and that they are most likely due to health-related behaviors or health status itself – particularly the burden of chronic disease, obesity, and depression," he said.

Counsel patients that the most important thing they can do to maintain their manhood, "or their mojo, is to prevent obesity. I think the most important target for preventing the decline in testosterone and all its consequences is to deal with the rapidly increasing obesity epidemic and maintain the healthiest possible lifestyle," Dr. Wittert said.

Men who maintained a normal weight had no change over time in testosterone. Those who lost weight showed a modest increase in the hormone. And men who transitioned from normal weight at baseline to obesity at follow-up showed a reduction in testosterone with no compensatory increase in luteinizing hormone levels, suggesting a central failure at the hypothalamic/pituitary level, he continued.

Dr. Wittert is the principal investigator in a six-center Australian prospective randomized trial that’s looking at whether testosterone replacement therapy plus a lifestyle intervention prevents progression from prediabetes to diabetes in hypogonadal men older than age 50 who are at increased risk. The control arm in the study, which is just beginning enrollment, will receive placebo plus the lifestyle intervention.

One of the hypotheses being tested is whether testosterone replacement improves motivation to engage in lifestyle change, a benefit that Dr. Wittert and others have observed anecdotally. Secondary end points in the study include the effect of testosterone replacement on cardiovascular disease risk and on bone health.

Testosterone levels tended to decline in smokers who quit. That’s clearly not a valid reason to continue smoking. Yet this intriguing relationship between smoking and testosterone is worthy of further investigation, in Dr. Wittert’s view.

The study is being funded by the National Health and Medical Research Council of Australia.