Use of calculated free testosterone in men: advantages and limitations.

IF 2.6 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Current Opinion in Endocrinology & Diabetes and Obesity Pub Date : 2024-12-01 Epub Date: 2024-10-09 DOI:10.1097/MED.0000000000000891

Jennifer Afrakoma Nyamaah, Nick Narinx, Leen Antonio, Dirk Vanderschueren

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Abstract

Purpose of review: Due to technical requirements and high cost, equilibrium dialysis-free testosterone (T) measurements are not commonly available in clinical practice. Clinicians rely on calculated free T (cFT) as a proxy. This review discusses using free T as a second-line assessment, highlighting its relevance in preventing misdiagnosis and overtreatment of male hypogonadism.

Recent findings: While there is consensus on measuring total T - comprising sex hormone-binding globulin (SHBG)-bound, albumin-bound, and free T - as a first step in diagnosing male hypogonadism, evidence confirms that aging and conditions like obesity influence both total T and SHBG levels. Furthermore, low free T has been associated with symptoms of androgen deficiency, even in men with normal total T. Clinicians should, however, be aware of limitations of free T calculations, particularly the lack of standardization. Recent developments include establishing age-stratified free T reference ranges measured by equilibrium dialysis.

Summary: Free T remains a subject of longstanding controversy. Factors such as age and obesity can alter total T and SHBG levels. Free T serves as a second-line indicator of androgen exposure, taking SHBG fluctuations into account. Given that commonly used free T calculators only provide approximations of free T, there is a need to further standardize free T calculators.

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在男性中使用计算游离睾酮：优势和局限性。

综述目的：由于技术要求和高昂的成本，平衡透析游离睾酮（T）的测量在临床实践中并不常见。临床医生依赖于计算游离睾酮（cFT）作为替代指标。本综述讨论了将游离 T 作为二线评估方法，强调其在防止误诊和过度治疗男性性腺功能减退症方面的重要性：虽然测量总 T（包括性激素结合球蛋白（SHBG）结合型、白蛋白结合型和游离 T）作为诊断男性性腺功能减退症的第一步已达成共识，但有证据证实，衰老和肥胖等情况会影响总 T 和 SHBG 水平。此外，游离 T 低与雄激素缺乏症状有关，即使总 T 正常的男性也是如此。不过，临床医生应注意游离 T 计算的局限性，尤其是缺乏标准化。最近的发展包括通过平衡透析测量建立年龄分层游离 T 参考范围：游离 T 长期以来一直存在争议。年龄和肥胖等因素会改变总 T 和 SHBG 水平。考虑到 SHBG 的波动，游离 T 可作为雄激素暴露的二线指标。鉴于常用的游离 T 计算器只能提供游离 T 的近似值，因此有必要进一步规范游离 T 计算器。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Opinion in Endocrinology & Diabetes and Obesity ENDOCRINOLOGY & METABOLISM-

CiteScore

5.80

自引率

3.10%

发文量

128

审稿时长

6-12 weeks

期刊介绍： Current Opinion in Endocrinology, Diabetes and Obesity delivers a broad-based perspective on the most recent and exciting developments in the field from across the world. Published bimonthly and featuring twelve key topics – including androgens, gastrointestinal hormones, diabetes and the endocrine pancreas, and neuroendocrinology – the journal’s renowned team of guest editors ensure a balanced, expert assessment of the recently published literature in each respective field with insightful editorials and on-the-mark invited reviews.