我们可以依靠总睾酮测量来排除勃起功能障碍中的性腺功能减退吗？

Can we rely on total testosterone measurement to exclude hypogonadism in erectile dysfunction?

——原载《国际阳痿研究杂志》2023年第35卷第5期——

<International Journal of Impotence Research>, 2023, 35 (5)

【摘要】尽管男性性腺功能减退症（MH）是勃起功能障碍（ED）患者常见的合并症，但其筛查仅依赖于总睾酮 (TT)。衰老和其他情况会增加性激素结合球蛋白 (SHBG) 并降低游离睾酮 (FT)，从而导致尽管TT正常但出现症状性MH。主要目的是测量ED患者中正常TT/低FT的患病率。2019年1月至2020年12月，对408名因性功能障碍转诊的患者进行了筛查；包括180名确诊为ED的男性。使用TT、SHBG、白蛋白和LH筛选MH。计算FT (cFT)。低TT、高SHBG和低cFT分别定义为<345ng/dL、>50nmol/L和<6.5ng/dL。根据TT/cFT状态和年龄组将患者分为几组。正常TT/低cFT的频率为17.2%。在所有31名TT正常/cFT低的患者中，只有4名（12.9%）患有甲状腺功能亢进、肝病或HIV感染，而23名（74.2%）年龄超过60岁。 与TT正常的患者相比，TT正常/低cFT的患者年龄较大（65.57±10.43vs. 56.79±10.63yo，p=0.001），且SHBG较高（78.48±40.14 vs. 52.35±20.39 nmol/L，p=0.014）/cFT。60岁以上的患者占样本的48.9%，其中52.5%的SHBG升高，正常TT/低cFT的频率为26.3%。正常TT/低cFT很常见，并且当前针对ED患者的MH筛查建议可能会漏掉。衰老似乎是罪魁祸首，因为60岁以后SHBG患病率急剧上升。对于出现ED的患者，尤其是60岁以上的患者，不能仅依靠TT来排除生化MH。目前急诊科MH筛查指南应予以修订。

[Abstract] Although male hypogonadism (MH) is a prevalent comorbidity in patients presenting for erectile dysfunction (ED), its screening relies solely on total testosterone (TT). Ageing and other conditions can increase sex hormone-binding globulin (SHBG) and lower free testosterone (FT) causing symptomatic MH despite normal TT. The primary objective was to measure the prevalence of normal TT/low FT among patients presenting for ED. From January 2019 to December 2020, 408 patients referred for sexual dysfunction were screened; 180 men with a confirmed diagnosis of ED were included. MH was screened using TT, SHBG, albumin and LH. FT was calculated (cFT). Low TT, high SHBG and low cFT were defined as <345 ng/dL, >50 nmol/L and <6.5 ng/dL, respectively. Patients were divided into groups according to TT/cFT status and to age group. The frequency of normal TT/low cFT was 17.2%. From all 31 patients with normal TT/low cFT, only four (12.9%) had either hyperthyroidism, hepatic disease or HIV infection, while 23 (74.2%) were older than 60 years. Patients with normal TT/low cFT were older (65.57 ± 10.43 vs. 56.79 ± 10.63 yo, p = 0.001) and had higher SHBG (78.48 ± 40.14 vs. 52.35 ± 20.39 nmol/L, p = 0.014) than patients with normal TT/cFT. Patients over 60 years represented 48.9% of the sample, 52.5% had elevated SHBG and their frequency of normal TT/low cFT was 26.3%. Normal TT/low cFT is frequent and can be missed by current screening recommendations for MH in patients presenting for ED. Ageing seems to be the main culprit as elevated SHBG prevalence increases steeply after the sixth decade. TT cannot solely be relied on to exclude biochemical MH in patients presenting for ED, especially in patients over 60 years old. Current guidelines for MH screening in ED should be amended.

论文原文：Afonso Morgado, Alberto Costa Silva, Paulo Diniz & Carlos Martins Silva (2023). Can we rely on total testosterone measurement to exclude hypogonadism in erectile dysfunction? International Journal of Impotence Research, 35 (5): 454–459.

https://doi.org/10.1038/s41443-022-00565-5

（需要英文原文的朋友，请联系微信：millerdeng95）