Alexander William Cloberry Lockie, Peter Grice, Raj Mathur, Ian Pearce, Vaibhav Modgil
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引用次数: 0
Abstract
Male hypogonadism is a clinical syndrome that results in low testosterone levels and frequently leads to infertility. The syndrome occurs due to disruption at one or more levels of the hypothalamic-pituitary-gonadal axis. Testosterone replacement therapy (TRT) is the most common treatment utilised for male hypogonadism. However, long-acting forms of TRT leads to infertility and so is inappropriate for patients wishing to conceive. For patients who wish to remain fertile, nasal TRT, clomiphene citrate, exogenous gonadotropins, gonadotropin releasing hormone and aromatase inhibitors have been used as alternative treatment options with different degrees of success. A review of the literature was performed to identify the safety and efficacy of alternative treatment options. Gonadotropin releasing hormone can successfully induce spermatogenesis but is impractical to administer. Likewise, aromatase inhibitors have limited use due to inducing osteopenia. Nasal TRT may be a good treatment option for these patients, but its efficacy has so far only been demonstrated in small sample sizes. However, clomiphene citrate and exogenous gonadotropins are safe, offer good symptom control and can successfully induce fertility in hypogonadism patients.
男性性腺功能减退症是一种临床综合征,会导致睾酮水平低下,并经常导致不育。该综合征的发生是由于下丘脑-垂体-性腺轴的一个或多个水平发生了紊乱。睾酮替代疗法(TRT)是治疗男性性腺功能减退症最常用的方法。然而,长效睾丸激素替代疗法会导致不育,因此不适合希望怀孕的患者。对于希望保持生育能力的患者,鼻腔TRT、枸橼酸克罗米芬、外源性促性腺激素、促性腺激素释放激素和芳香化酶抑制剂已被用作替代治疗方案,并取得了不同程度的成功。我们对文献进行了回顾,以确定替代治疗方案的安全性和有效性。促性腺激素释放激素可成功诱导精子发生,但在使用上并不实用。同样,芳香化酶抑制剂也会诱发骨质疏松,因此使用范围有限。对这些患者来说,鼻腔 TRT 可能是一个不错的治疗选择,但其疗效迄今仅在小样本量中得到证实。不过,枸橼酸克罗米芬和外源性促性腺激素是安全的,能很好地控制症状,并能成功诱导性腺功能减退症患者生育。
期刊介绍:
International Journal of Impotence Research: The Journal of Sexual Medicine addresses sexual medicine for both genders as an interdisciplinary field. This includes basic science researchers, urologists, endocrinologists, cardiologists, family practitioners, gynecologists, internists, neurologists, psychiatrists, psychologists, radiologists and other health care clinicians.