Lefats'e J Mens Health. 2013 August; 31(2): 126-135.
inahaneloang
Testosterone e bohlokoa ho physiology ea litho tse fapaneng le lisele. Sekhahla sa testosterone sa serum se fokotseha butle-butle e le e 'ngoe ea lits'ebetso tsa botsofali. Kahoo, mohopolo oa hypogonadism ea morao-rao o hapile tlhokomelo lilemong tse 'maloa tse fetileng. Matšoao a tlalehiloeng a hypogonadism ea morao-rao a tsejoa habonolo mme a kenyelletsa ho fokotseha ha takatso ea thobalano le boleng ba erectile, haholo-holo ha ho etsoa bosiu, ho fetoha ha maikutlo le ho fokotseha ha ts'ebetso ea kelello le boits'oaro ba sebaka, mokhathala, khatello ea maikutlo le bohale, phokotso ea boima ba 'mele bo bobebe le e amanang le ho fokotseha ha bophahamo ba mesifa le matla, ho fokotseha ha moriri oa mmele le liphetoho tsa letlalo, le ho fokotseha ha letsoalo la masapo a masapo ho hlahisang lefu la masapo. Har'a matšoao ana a fapaneng, ho se sebetse ka thobalano e bile eona e tloaelehileng le e hlokahalang ho phekoloa lefapheng la urology. Hoa tsebahala hore boemo bo tlase ba serum testosterone bo amahanngoa le ho se sebetse ha erectile le libido tsa thobalano tse se nang boikaketsi le hore kalafo ea testosterone e ka ntlafatsang matšoao ana ho bakuli ba nang le hypogonadism. Haufinyane, ntle le ts'oaetso ea thobalano, kamano e haufi lipakeng tsa ts'oaetso ea metabolism, e khetholloang ke botenya bo boholo, insulin ho hanyetsa, dyslipidemia, le khatello ea mali, le hypogonadism ea morao-rao e totobalitsoe ke lithuto tse 'maloa tsa lefu la seoa. Liteko tse 'maloa tsa taolo e sa sebetseng li bontšitse hore kalafo ea phetolo ea testosterone e fokotsa ho hanela insulin ha mmele ho kenyelletsa molemo oa eona oa botenya. Ntle le moo, ts'oaetso ea metabolism ke e 'ngoe ea lisosa tse kholo tsa lefu la pelo, mme boemo bo tlase ba testosterone ba serum bo amana haufi le kholo ea atherosclerosis. Hajoale, ho nahanoa hore tekanyo e tlase ea testosterone ea serum e ka eketsa kotsi ea lefu la pelo. Kahoo, testosterone ke molek'hule ea bohlokoa bophelong ba banna, haholoholo ba banna ba tsofetseng.
SELELEKELA
Testosterone e sebelisa boholo ba ts'ebetso ea eona ea tlhaho ka ho tlama le li-androgen receptor tse fumanehang ka har'a li-cell tsa lisele tse shebiloeng. Hoa tsebahala hore testosterone e bohlokoa ho physiology ea litho tse fapaneng le lisele tse ho tsona li-androgen receptor, joalo ka letlalo, mesifa, sebete, masapo le masapo a mokokotlo, bokong le litho tsa thobalano. Leha ho le joalo, e le e 'ngoe ea mekhoa ea botsofali, khatello ea serum testosterone butle-butle e fokotseha ka 1.6% ka selemo ka botsofaling, haholo-holo ka mor'a lilemo tsa 40. Kahoo, polokeho ea motsoako oa physiologic ea serum testosterone, esita le ho banna ba tsofetseng, e amohetse tlhokomelo e pharalletseng hobane litekanyetso tse tlase tsa serum testosterone li amana le lefu le eketsehang la lefu ho banna ba veteran.1 Mabapi le taba ena, mohopolo oa hypogonadism ea nako ea morao-rao (LOH) o hlahelletse lilemong tsa morao tjena. LOH e 'nile ea hlalosoa e le' lefu la kliniki le tšebetso ea lik'hemik'hale le amanang le botsofali 'me le tšoauoa ka matšoao a tloaelehileng le khaello ea litekanyetso tsa serum testosterone' ke Mokhatlo oa Machaba oa Andrology (ISA), Mokhatlo oa Machabeng oa Boithuto ba Monna ea Tsofetseng (ISSAM ), Le European Association of Urology (EAU) ka 2005.2 European Male Ageging Study ea banna ba 2,966 ba lilemong tse mahareng le banna ba tsofetseng ba fumane sekhahla sa LOH (serum palo ea testosterone ea <3.2 ng / ml, boemo ba testosterone ba mahala ba <64 pg / ml, le bonyane matšoao a mararo a thobalano) ka 2.1% ea banna ba pakeng tsa lilemo tse 40 le 79.3 Japane, bukana ea koetliso ea bongaka bakeng sa LOH e boetse e ngotsoe mme ea phatlalatsoa ke sehlopha se kopaneng se tsoang ho Japan Urological Association (JUA) le Mokhatlo oa Japane bakeng sa Study of the Aging Male (JSSAM) ho khothaletsa mekhoa e tloaelehileng ea ts'oaetso, kalafo, thibelo, le ho lekola liphetoho tse fapaneng ka lebaka la kalafo ea phetisetso ea testosterone (TRT), le tlhahlobo ea kamora kalafo.4 Matšoao a tlalehiloeng a LOH a bonoa habonolo mme a kenyelletsa takatso e tlase ea thobalano le boleng ba erectile, haholo mesebetsing ea bosiu, liphetoho tse bang teng maemong a kelello le ho fokotseha hoa maikutlo, ho tepella maikutlo, khatello ea maikutlo le khalefo, ho fokotseha ha boima ba 'mele le ho fokotseha ho amanang le ona ho fokotseha ho bophahamo ba mesifa le matla, ho fokotseha ha moriri le liphetoho tsa letlalo, le ho fokotsa bongata ba liminerale tsa masapo.5-10 Har'a matšoao ana a LOH, ho hloka thobalano e bile ntho e atileng haholo ebile e hlokahalang ho phekola lefapheng la urology. Haufinyane, ntle le bothata ba thobalano, kamano e atamelaneng pakeng tsa LOH le metabolic syndrome (MS), e khetholloang ke botenya bo bohareng, ho hanyetsa insulin, dyslipidemia, le khatello ea mali, li totobalitsoe ke lithuto tse 'maloa tsa lefu la sethoathoa. Hoa tsebahala hore MS e tloaelehile ebile e amahanngoa le mafu a 'maloa a bophelo, empa lebaka la bohlokoahali la hore MS e fumane tlhokomelo lefapheng la bophelo bo botle ba sechaba ke ho tloaelana ha eona le kotsi e eketsehang ea lefu la pelo le methapo (CVD). Kahoo, hoa utloahala hore kamano pakeng tsa testosterone le CVD le eona e amohetse tlhokomelo e eketsehileng.
Tlhahlobisong ena, re shebana le kamano lipakeng tsa boemo ba serum testosterone le maloetse a mararo - ho se sebetse ka thobalano, lefu la ts'oaetso, le CVD - ho latela bophelo ba banna.
PUSELETSO YA SEXUAL
Ka kakaretso, ho se sebetse ka thobalano ho ama haholo boleng ba bophelo ba banna. Ho se sebetse ka thobalano, haholoholo ts'oaetso ea thobalano, ho fokotsa bosiu le hoseng, ho se sebetse ha erectile (ED), ho lieha ho emisa, le ho fokotsa molumo oa peo, li hlahelletse ebile hangata ke matšoao a hlahisang banna ba nang le boemo bo tlase ba testosterone. Har'a matšoao a 'maloa a thobalano, ts'ebetso ea erectile e hapile tlhokomelo e kholo mme e nkuoa e amana haholo le boemo ba testosterone ea serum. Hape hoa tsebahala hore boemo bo tlase ba testosterone ea serum hangata ha se sesosa se seholo sa ED ho monna ea tsofetseng, leha liphetoho tsa lihormone li ka bapala karolo e tlatselletsang maemong a mangata a ED. Leha ho le joalo, ka kakaretso hoa amoheloa maemong a bongaka hore banna ba feretsoeng ba na le ts'oaetso ea erectile le hore tsoho e tloaelehileng e latela testosterone, joalo ka ha lithuto tse ngata tsa liphoofolo li fane ka bopaki ba karolo ea testosterone ts'ebetsong ea erectile.11-14 Ntle le moo, ho tlalehiloe hore erection ea nocturnal e boetse e fokola haholo ho bakuli ba nang le serum testosterone e tlase ho feta ho banna ba nang le serum testosterone e tloaelehileng,15 leha testosterone e sebetsa kae le kae ts'ebetsong ea erection e ntse e tlameha ho hlakisoa ho batho. Re kile ra tlaleha hore lintlha tsa International Index tsa Erectile Function-5 ea mosebetsi oa erectile e eketsehile haholo ka keketseho ea serum testosterone thutong ea banna ba 130 ba nang le matšoao a ho se sebetse hantle ka thobalano.10 Bohlokoa ba mantlha ba testosterone maemong a mangata a litsela tse sebeletsang kemiso ea penile, ho tloha cortex ho isa bohareng ba mokokotlo le lesapo la mokokotlo ho isa liseleng tsa mesifa e boreleli le ts'ebetso ea endothelial, e fana ka maikutlo a boemo ba testosterone e le sebaka sa bohlokoa taolong ea bakuli ba bangata ba nang le Ed. Mabapi le ts'ebetso ea testosterone ntlafatsong ea ts'ebetso ea erectile, thuto ea liphoofolo e bontšitse hore testosterone e na le karolo e hlakileng le e kholo ea ho boloka ts'ebetso ea nitric oxide synthase ka ho sa feleng.16 Ho batho, ho ile ha boela ha tlalehoa hore tsamaiso ea testosterone undecanoate e lebisitse ho khutlisong ea litekanyetso tsa testosterone tsa plasma ho bakuli ba hypogonadal ED le ho ntlafatsa maikutlo a thobalano le ts'ebetso ho 61% ea lithuto.17 Phetoho ea bohlokoa ea ts'ebetso ea erectile ha e bapisoa le placebo e fumanoe tlhahlobisong ea meta-17 ea liteko tse laoloang tse sa sebetseng (RCTs) tsa banna ba lilemo li mahareng le ba tsofetseng ba nang le maemo a tlaase a testosterone.18 Ka kakaretso, khetho ea pele ea kalafo bakeng sa ED e bile taolo ea inhibitor e khethiloeng ea mofuta oa phosphodiesterase 5 (PDE5-I) ho tloha ha ho qala sildenafil citrate. Le ha PDE5-Is e le kalafo e mamelloang hantle bakeng sa ED, sechaba se ikhethileng sa bakuli se nkuoa e le phephetso ho se phekola mabapi le kalafo ea PDE5-I se kenyeletsa bakuli ba nang le ts'enyo e matla ea methapo e kang e bakoang ke radical prostatectomy, lefu la tsoekere le lefu la methapo e matla. .19 Ka hona, ho hlokahala mekhoa e meng ea phekolo ho hlola bothata bona. Mabapi le sena, ho tlalehiloe hore TRT e ka khutlisa li-erections ho banna bao qalong ba neng ba sa ka ba arabela karabo ho PDE5-I20,21 le hore e bohlokoa haholo ho banna ba hypogonadal ba nang le testosterone baseter e nang le palo ea mantlha ea <3 ng / ml, joalo ka ha e fumanoa ho RCT.22 Hajoale, ha ho na pelaelo hore tokisetso ea testosterone e ka ba sesebelisoa se eketsehileng kalafong ea ED, hammoho le PDE5-I.
Takatso ea botona le botšehali ke e 'ngoe e hlahelletseng' me hangata ke letšoao le hlahang hammoho le ED. Libido e tlase kapa e sieo e ka ba ka lebaka la palo e theohileng ea testosterone, empa e ka boetse ea e-ba phello ea lintlha tsa psychogenic, lintho tse ling, kapa bokuli bo sa foleng. Ka sebele, litsebi tsa urologist li tseba ka ho nyamela kapele ha libido ho banna ba tšoaroang ka bongaka kapa bongaka bo fetisisang, leha ho na le banna ba bang bao takatso ea bona ea thobalano e bolokiloeng. Lithuto tse 'maloa tse amanang le maemo a holimo li bontšitse tšebelisano e kholo pakeng tsa khatello ea serum testosterone le boemo ba takatso ea thobalano litabeng tsa botsofaling23,24 le banna ba nang le ED.25,26 Phuputso e telele e boetse e bontšitse kamano e haufi lipakeng tsa serum testosterone level le takatso ea thobalano.27 Phuputso ea County ea Olmsted, e nang le palo e kholo ea lithuto, e bontšitse kamano pakeng tsa tekanyo e phahameng ea testosterone le keketseho ea takatso ea thobalano.28 Ha takatso ea thobalano e fokotsehileng e bakoa haholo ke hypogonadism, lipatlisiso tse peli tsa meta-RCT li bonts'itse ntlafatso e kholo litakatsong tsa thobalano kamora TRT.25,26 Ka hona, ho lumeloa hore boemo ba testosterone serum ea testosterone bo bohlokoa molemong oa takatso e tloaelehileng ea thobalano. Letšoao le leng la thobalano le amanang le testosterone ntle le ED le takatso ea botona le botšehali ke ho se sebetse hantle. Leha ho le joalo, likamano lipakeng tsa testosterone le ts'ebetso ea kemolo e sa ntse e nahana haholo,29 leha e tsebahala haholo maemong a bongaka a hore testosterone e kenya letsoho bophahamong ba ejaculate le boleng ba emong. Ho senyeha ka mokhoa o makatsang joalo ka ho emisoa kapa ho ts'oaroa ha nakoana ke sona se ithutoang hanyane ebile se utloisisoa hanyane ka hanyane ka thobalano ka lebaka la rarollo ea boemo le ho se be teng hoa kalafo e sebetsang. Litokisetso tsa testosterone e kanna ea ba sesebelisoa sa kalafo. Ka 'nete, mabapi le ho sebetsa hantle ha TRT ho phekoleng ho senyeha ha methapo ea kutlo, ntlafatso e kholo ho bokhoni ba ejaculatory e fumanoe ho banna ba tepeletseng ba nang le maemo a tlase a testosterone ba ileng ba tsoela pele ho nka li-antidepressants tsa serotonergic. Ha testosterone e thehiloe hammoho, e amana haufi le mefuta e mengata ea khatello ea thobalano e kang ED, takatso e matla ea thobalano, khatello ea kelello le ho se sebetse hantle.30
LIEKETSO METABOLIC
MS e tšoauoa ke botenya bo bohareng, ho hanyetsa insulin, dyslipidemia, le khatello ea mali hape ke mofuta o mong oa lefu o amang boleng ba bophelo bo amohelang tlhokomelo e eketsehileng masimong a bongaka le bophelo bo botle ba sechaba.31 Pathogenesis ea MS ke multifactorial, empa mohato oa pele e kanna ea ba botenya bo boholo hobane sena se hokahane le khatello ea mali, ho eketseha ha serum low-density lipoprotein (LDL), serum high-density lipoprotein (HDL), le hyperglycemia.31 Ho ile ha tlalehoa hore ho na le kamano e haufi pakeng tsa maemo a serum testosterone le boemo ba botena ho banna.32,33 Haholo-holo, ho ile ha hatisoa hore botenya bo bohareng bo amana haholo le boemo ba testosterone ea serum.34-36 Ho kile ha tlalehoa hore ho banna ba tsofetseng, boima ba 'mele le mesifa ea mesifa e na le serum ea testosterone ea mahala.37-39 Ntle le moo, ho amoheloa kliniking hore botenya bo kenya letsoho ho qaleheng ha lefu la tsoekere, e leng e 'ngoe ea lintlha tsa tlhahlobo ea mafu a marang-rang a MS.
Mabapi le lefu la tsoekere, ho tsejoa haholo ho urology hore kalafo ea ho fokotsa khatello ea androgen ho bakuli ba nang le mofetše oa lefu la senya e eketsa ho hanyetsa insulin,40,41 ka 'nete, boemo ba testosterone ka kakaretso bo amana ka ho hlaka le khatello ea insulin le ho hanyetsa insulin ho banna.42 Liphuputso tse 'maloa tsa lefu la banna li bontšitse hore ho na le kamano e haufi pakeng tsa serum testosterone e tlase le mofuta oa 2 lefu la tsoekere la mellitus (T2DM).43-45 Haufinyane, ho tlalehiloe hore hoo e ka bang karolo ea boraro ea banna ba nang le T2DM ba teng le LOH.46 Leha ho le joalo, sephetho se khahlisang ho feta sa kamano e haufi pakeng tsa boemo bo tlase ba serum testosterone le T2DM lithutong tse arohaneng ke taba ea hore tekanyo e tlase ea serum testosterone ke eona e tlang pele liketsahalong tsa insulin ho hanyetsa le T2DM, joalo ka ha ho bonts'itsoe lithutong tse telele. ya banna ba phetseng hantle.47-49 Ha ho nahanoa ka katleho ea TRT bakeng sa lefu la tsoekere, li-RCT tse tharo tse kholo tsa morao-rao li bontšitse ho fokotseha ho hoholo ha insulin,50-52 leha liphetoho tse hlahisitsoeng ke testosterone ho metabolism ea glucose li ntse li bonahala li sa lumellane ebile li bitsitsoe hanyane ho feta kamoo ho neng ho ka lebelloa.
Ha e le kamano pakeng tsa tekanyo e tlase ea serum testosterone le lipids, keketseho ea cholesterol ea serum, cholesterol ea LDL, le triglycerides, le ho fokotseha ha cholesterol ea HDL ho fumanoe ho banna ba nang le kankere ea senya ea senya ea androgen.53 Ho sebetsa hantle ha TRT bakeng sa metabolism ea lipid hammoho le ho hanyetsa insulin ho tlalehiloe ke tlhahlobo ea morao-rao ea li-RCT le banna ba lilemo li mahareng le ba tsofetseng hoo testosterone ea kantle e fokotsitseng boemo ba serum ba cholesterol e felletseng le LDL cholesterol.18,54
Mabapi le khatello ea mali, ho boetse ho phehiloe khang ea hore kamano e sa lumellaneng pakeng tsa tekanyo ea testosterone ea serum le khatello ea mali e teng, leha phello ea testosterone ho khatello ea mali e ntse e sa hlaka. Ho tlalehiloe pele hore testosterone ea transdermal e bonts'a phokotso e kholo ea khatello ea mali ea diastolic ho banna ba batenya haholo.55 Phuputso e 'ngoe e bontšitse phokotso e kholo lithutong tsa mali tsa systolic le diastolic ka bobeli ke TRT bakeng sa banna ba nang le lefu la masapo.56 Ho feta moo, TRT e kopantsoeng le lijo le boikoetliso e ne e sebetsa hantle mesebetsing ea antihypertgent ho feta kalafo ka lijo le ho ikoetlisa e le 'ngoe ho banna ba nang le MS.57 Phuputso e lebelletsoeng e bonts'itse hore karolo e tlase ea serum testosterone maemong a mantlha e bolela esale pele nts'etsopele ea khatello e phahameng ea mali.58 European Male Aging Study ea 2,966 ea lilemo li mahareng le ea tsofetseng e bonts'a hore banna ba nang le LOH ba ne ba e-na le 'mele o moholo oa Mass Mass Index (BMI), sebaka se phahameng sa thekeng, cholesterol e tlase ea HDL, triglycerides e phahameng, khatello e phahameng ea mali ea systolic, le glucose e phahameng, le litekanyetso tsa mohlala tsa homeostasis-likhakanyo tsa khanyetso ea insulin (HOMA-IR).59 Ka lehlakoreng le leng, likotsi tsa ho ba le serum testosterone e tlase li ne li phahame haholo ho banna ba nang le khatello ea mali (1.84), hyperlipidemia (1.47), lefu la tsoekere (2.09), le botenya (2.38) thutong le banna ba fetang 2,000 ba lilemo tse ka bang 45 ea lilemo li.60 Ho nkuoa hammoho le lithuto tse ling tse hlahlojoeng sengoliloeng sena, ho nahanoa ka matla hore tekanyo e tlase ea serum testosterone e amahanngoa le lintlha tse 'maloa tsa metabolic ka bonngoe, ho kenyelletsa botenya, hyperglycemia, hyperlipidemia, le khatello ea mali, le ha mokhoa oa mokhatlo ona o sa ka oa hlakisoa ka ho lekaneng. .
Le ha TRT e ne e lebelletsoe ho ba leano le lecha la kalafo bakeng sa MS, ho ameha ho teng mabapi le phetoho maemong a serum adiponectin e kanna ea bakoa ke TRT. Adiponectin ke eona e nang le li-adipocytokine tse ngata ka ho fetisisa ebile li na le litlamorao tse matla tse khahlanong le lefu la tsoekere, anti-atherogenic le anti-inflammatory, hape ho lumeloa hore ke molek'hule oa bohlokoa ho etiology ea MS.61,62 Ho hobe ka ho fetisisa, boemo ba serum adiponectin bo amana ka ho fetelletseng le boemo ba testosterone.63 Ho tlalehiloe ka palo e nyane ea batho hore maemo a serum adiponectin ho banna ba hypogonadal a phahame haholo ho feta a banna ba eugonadal le hore likhoeling tsa 6 ka mor'a ho qalisoa ha TRT, e ileng ea eketsa litekanyetso tsa serum testosterone ho fihla maemong a tloaelehileng, litekanyetso tsa adiponectin li fokotsehile haholo ho banna ba hypogonadal.64 Kahoo, monyetla oa TRT bakeng sa MS o bile le phehisano hobane TRT e ka mpefatsa MS ka lebaka la litekanyetso tse theohileng tsa adiponectin. Mabapi le ntlha ena, re tlalehetse pejana hore ha ho kamano e fapaneng pakeng tsa maemo a adiponectin le testosterone ho bakuli ba tsofetseng ba nang le lefu la LOH le hore TRT ha e ame maemo a adiponectin ho banna ba baholo.65 Kahoo, TRT, haholo-holo ho bakuli ba nang le LOH, ha e bonahale e beha kotsi e kholo ea ho hohela MS ka lebaka la ho fokotseha ha litekanyetso tsa serum adiponectin. Hajoale, TRT e kanna ea ba mofuta o le mong oa kalafo ea boikhethelo bakeng sa MS, leha lithuto tse eketsehileng tse nang le palo e kholo ea bakuli li tla hlokahala ho netefatsa polokeho le ts'ebetso ea eona.
Testosterone e tlase ea serum ha e amahanngoe feela le likarolo tsa motho ka mong tsa MS empa hape le MS ka boeona. Litekanyetso tse tlase tsa serum testosterone ho tlalehiloe hore li amana ka ho toba le MS maemong a sefapano66 le lithuto tse telele.67 Liphuputso tse 'maloa tsa morao-rao li bontšitse hore boemo ba serum testosterone bo tlaase haholo ho ba nang le MS ho feta ho ba se nang MS.68,69 Tlhahlobo ea morao-rao ea litlhahlobo tse entsoeng ka palo e kholo ea lithuto le MS e boetse e bonts'itse hore serum testosterone level e ne e le tlase ho banna ba nang le MS ho feta ho banna ntle le MS (ho bolela phapang, -2.64 nmol / L; 95% interval [CI] , -2.95 ho -2.32).70 Ho fumanoe lintho tse tšoanang ha li fumanoe feela lithutong le banna ba Caucasian empa le lithutong le banna ba Asia. Phuputso e entsoeng ke banna ba Japane ba lilemong tse bohareng ba neng ba etsa liteko tse akaretsang tsa bophelo bo botle e bonts'itse hore serum testosterone level e boetse e theohile haholo sehlopheng se nang le MS ho feta ntle le MS, mme boemo ba testosterone bo ile ba fokotseha haholo tumellanong le keketseho ea palo ea MS likarolo tse teng.71 Phuputso eo e boetse e bonts'a hore kamora phetoho ea lilemo, BMI, le bophara ba kiist, boemo ba testosterone bo ne bo ntse bo hokahana haholo le MS. Phuputso e 'ngoe e nang le banna ba Japane ba lilemong tse bohareng le eona e bontšitse hore boemo bo tlase ba serum testosterone bo ne bo amana haholo le e' ngoe ea lintlha tsa MS ka tlhahlobo ea liphetoho tsa maemo tse amanang le lilemo.72 Hape re fumane hore monyetla o phahameng oa MS o ne o amahanngoa ka ho hlaka le testosterone e tlase ea serum ka mokhoa o hlophisitsoeng oa lilemo o nang le banna ba 1,150 ba lilemo li mahareng ba phetseng hantle. Ho khahlisang ke hore boleng ba kliniki ea serum testosterone e le sesosa sa ponelopele ea nts'etsopele ea MS bo sa tsoa tlalehoa; phuputso ea meta ea lithuto tsa bolelele ba nako e bonts'a hore boemo ba testosterone ba mantlha e ne e le 2.17 nmol / L tlase ho banna ba nang le ketsahalo ea MS ha ba bapisoa le taolo (p <0.0001).73 Hajoale, ho amoheloa hantle hore tekanyo e tlase ea serum testosterone e hlahile e le kholo ea 'nete ea "metabolism" ea MS ho banna bao khaello ea testosterone e leng liphatsa tsa lefutso kapa iatrogenic e latelang ts'ebetso ea bongaka.67,74,75 kapa pharmacologically e hlahisoang ke li-hormone tsa gonadotropin tse lokollang nakong ea kalafo ea mofetše oa senya.76
KHOTSO CARDIOVASCULAR
Nakong e fetileng, testosterone e ne e lumela hore e na le litlamorao tse mpe mosebetsing oa pelo le pelo. Leha ho le joalo, tlhahlobo ea meta-analysis ea lefutso e bonts'a hore karolo ea serum testosterone e tlase ho bakuli ba nang le CVD.77 Ho khahlisang, kamano e lipakeng tsa serame ea testosterone e tlase le CVD thutong eo ha ea ka ea theoha molemong oa ho ngolisa lintho ka mor'a ho feto-fetoha le maemo a lilemo, BMI, lefu la tsoekere le khatello ea mali. Lipampiri tsa tlhahlobo ea morao-rao li boetse li hlakisitse bohlokoa ba palo e fokotsehileng ea testosterone serum le CVD.78,79
Atherosclerosis e tsejoa e le sesosa se seholo sa kotsi bakeng sa CVD. Ho hlahloba atherosclerosis, flow-mediated dilation (FMD) ea brachial artery and intima media thickness (IMT) ea mokokotlo oa carotid e 'nile ea sebelisoa ka bongaka e le matšoao a ka lekanngoang hobane ho thata ho bona khafetsa ho lekanya boteng ba lipalo tsa aortic tse bonts'itsoeng.80 Kopano ea tekanyo e tlase ea testosterone e nang le FMD e fokotsehileng ho banna ba nang le mabaka a mangata a kotsi ea CVD e ne e se e tlalehiloe ho tsoa sehlopheng sa lipatlisiso sa Majapane.81 Lithuto tse ling tse 'maloa tsa banna li bontšitse liphumano tse ts'oanang, ho hore palo e tlase ea serum le / kapa litekanyetso tsa mahala tsa testosterone li amana haholo le FMD e fokotsehileng.82,83 Mokhatlo o arohaneng oa IMT ka tekanyo ea serum testosterone o boetse o tlalehiloe thutong ea mefuta e 'maloa e ikhethang ea lithuto tse kang banna ba baholo haholo.84 banna ba nang le T2DM,85 le banna ba batenya haholo ba nang le mamello ea tsoekere.86 Haufinyane tjena, palo e kholo ea banna e sebelisang palo ea banna le eona e bonts'itse boemo ba testosterone ka kakaretso ba kamano e amanang le IMT e fetotsoeng lilemo.87 Phuputsong eo, mokhoa o hlophisitsoeng oa ho hatella o hlophisitsoeng bakeng sa phello e makatsang ea lintlha tsa kotsi tsa CVD o bonts'itse hore banna ba nang le maemo a testosterone maemong a tlase haholo ba ne ba e-na le karo-karolelano e ikemetseng (1.51) ea ho ba maemong a phahameng ka ho fetisisa a IMT.87 Phuputso e 'ngoe ea morao-rao ea banna ba lilemo tse mahareng ba nang le bofokoli ba testosterone e tlaleha hore IMT e amana hantle le boemo ba testosterone ba serum mefuteng ea multivariate e fetotsoeng lilemo le mekhoa e mengata ea bophelo le lintlha tsa metabolic.80 Re boetse ra fumana hore karolo e tlase ea testosterone ea mahala ea serum e ne e amana le boemo bo phahameng ba IMT ho banna ba lilemo li mahareng ba Japane le hore mokhatlo ona ha oa ka oa latela mohlala oa multivariate o fetotsoeng bakeng sa lilemo le mabaka a 'maloa a amanang le tleliniki.88 Ho khahlisang, phuputso e telele e boetse e fumane banna ba nang le tekanyo e tlase ea serum testosterone hore ba ne ba phahamisitse IMT nakong ea ho latela 4 ea lilemo tse latelang.89 Ntle le liphetho tsa FMD le IMT, hoa tsebahala hore banna ba nang le serum testosterone e tlase ba na le litekanyo tse tlase tsa lisele tsa endothelial progenitor, tse etsang karolo ea bohlokoa ho lokisa le ho boloka ts'ebetso ea endothelial mme li fokotsehile ho banna ba nang le CVD.90,91 Ho khahlisang, ho tlalehiloe hore TRT e ka eketsa boemo ba lisele tsa prootitor tse potileng ho banna ba nang le hypogonadism.92 Kahoo, hajoale, ho lumeloa hore testosterone ke molek'hule e bohlokoa ntlafatsong ea atherosclerosis.
Ho nahanoa hore testosterone e ka ntlafatsa pelo ischemia ka ho sebetsa e le vasodilator ea coronary hobane e ne e se e netefalitsoe hore taolo e matla ea testosterone esita le ho tsepamisa mohopolo ka ho toba methong ea coronary ho banna ba tsamaeang le catheterization ea pelo e eketsang phallo ea mali le corodary vasodilatation ka mokhoa o itšetlehileng ka tekanyetso. mokhoa.93 Li-RCT li bontšitse hore TRT e eketsa nako ea khatello ea maikutlo ea 1-mm ST nakong ea liteko tsa boikoetliso94 hape e ntlafatsa nako ea ho tepella maikutlo ho ST ho banna ba hypogonadal ba nang le angina e sa foleng.95,96 Bakeng sa banna ba Japane ba lilemong tse mahareng ba nang le maemo a kotsi ea coronary, tlhahlobo ea ho latela le eona e bontšitse hore boemo bo tlase ba serum testosterone bo amana le liketsahalo tsa pelo.97 RCT e bontšitse hore boemo ba 'mele bo khothalletsoang ke tsamaiso e sa fetoheng ea tokisetso ea testosterone bo ntlafatsa boemo ba pelo ho banna ba nang le bothata ba pelo le ho ferekana hoa banna ba nang le lefu la pelo.98 Ehlile ho tlalehiloe hore maemo a tlase a serum testosterone a amahanngoa le lefu le eketsehang la lefu la pelo ho banna.99-101 Ho hakanyetsa boleng ba ponelo-pele ea serum testosterone boemo ba mefuta eohle ea CVD moriana le lefu, tlhahlobo ea meta ea 19 lithuto tse lebelletsoeng tsa banna ba tsofetseng li ile tsa etsoa moo testosterone e fumanoeng e na le phello e fokolang ea boits'ireletso e ikemiselitseng ka kotsi e lekantsoeng ea setho 0.89 (CI 0.83 ~ 0.96) bakeng sa phetoho ea ho kheloha ho tloaelehileng ha 1 maemong a serum testosterone.102 Kahoo, matsatsing ana, likhopolo tsa hore tekanyo e tlase ea serum testosterone li ka eketsa kotsi ea ho ba le CVD le hore TRT e kanna ea ba le phello e ntle ho CVD e atile hobane lithuto tse ngata tsa nakoana li bontšitse litholoana tse ntle. Bonyane, butle-butle e amohetse hore khaello ea testosterone ke letšoao la lefu la pele ho banna mme e amana haholo le ho ba teng le degree ea atherosclerosis, leha ho ntse ho sa hlake hore na bofokoli ba testosterone ke sesosa kapa phello ea atherossteosis.
CONCLUSIONS
Ha ho pelaelo hore testosterone ke e 'ngoe ea lintlha tsa bohlokoa bophelong ba banna sechabeng sena se tsofetseng. Tlhokomelo e khethehileng e tlameha ho nkuoa mabapi le MS le CVD ho banna ba tsofetseng ba nang le boemo bo tlase ba serum testosterone, leha lithuto tse kenelloang tse lebelloang, tsa nako e telele le tse laoloang ke placebo li hlokahala ho fihlela qeto e tiileng ea hore TRT e sebetsa hantle kalafong ea MS le CVD hammoho le bothata ba thobalano.
References