男性四、五十歲後睪固酮減少，補充睪固酮必要性

一般男性到了四、五十歲後，雄性激素機能逐漸衰退，特別是睪固酮的分泌減少。

缺少「性」致，進入「男性更年期」

62歲的吳先生，已婚，是企業負責人。抱怨近四年來，每年皆有數次「症狀」發作。因為工作關係，他必須經常出國洽商。四年前一次返國後，因時差調整較不順利，開始出現失眠，就醫後依醫師指示服用安眠鎮定藥物。幾年下來，逐漸對藥物產生依賴及耐受性，原先的劑量已無法改善失眠症狀。

他經常晚餐過後感到從耳根、臉上到脖子有發熱及發漲的不舒服感，加上失眠嚴重，出現焦慮、煩躁不安、沒耐心、易發脾氣等情形。過去依然可以「性」致勃勃，近年來卻是提不起勁、甚至欲振乏力。

經檢查後發現吳先生的總體睪固酮與游離睪固酮均偏低，動情素(LH)與促濾泡成熟激素(FSH)上升，泌乳素(prolactin)與攝護腺特異抗原(PSA)正常。此外，根據病史及男性老化症狀量表篩檢，有性功能障礙及明顯身心症狀。依照ISSM(國際男性老化研究醫學會)的認定標準，推測吳先生進入「男性更年期」。

一般男性到了四、五十歲後，雄性激素機能逐漸衰退，特別是睪固酮的分泌減少。因體內荷爾蒙分泌的變化所產生的身心不適，稱為「男性更年期」。由於男性不存在「停經」的信號，臨床上不易確定其發生及過程。一般來說，男性更年期比女性晚十年發生。每個人在更年期時有不同的表現：有些人發生荷爾蒙下降的現象，卻沒有明顯的症狀；有些人出現惱人的更年期困擾，但仍保有正常分泌的雄性激素。約30%的40-70歲男性會出現更年期的臨床症狀：情緒不穩定、沮喪、憂鬱、熱潮紅、心悸、盜汗、性慾降低、性功能障礙、缺乏活力、易倦怠、失眠、記憶力及注意力下降、上半身脂肪增加、肌肉鬆弛、張力降低等。


睪固酮補充治療

睪固酮對男人的健康至關重要。睪固酮是一種男性荷爾蒙，對男性生殖系統、性功能、精神狀態、肌肉質量、骨骼健康等方面都有重要的影響。

補充睪固酮膠囊是一種常見口服補充劑，旨在提高男性睪酮水平。它們通常包含天然或合成的睪酮類似物質，可以直接進入血流中，以增加身體的睪酮水平。

補充睪酮可以幫助男性增強性慾、改善性功能、增加肌肉質量、減少脂肪和增強骨骼健康等。針對「男性更年期」患者，睪固酮補充除了可以減小腰圍、提升男性性功能之外、也可改善三高控制、骨質密度、記憶與憂鬱症狀。

荷爾蒙輔助治療藥物(男性荷爾蒙補充劑) Cernos 睪固酮膠囊

根據歐洲及美國的治療指引，建議患者需要符合下列兩項條件：

一、 有睪固酮低下相關的症狀及診斷；

二、 低於正常的睪固酮抽血數值，由主治醫師評估及檢查確認後，才治療。美國泌尿外科學會（AUA）建議在提供睪固酮補充治療之前，臨床醫生應測量血紅素濃度和血球容積比（HCT），並告知患者紅血球增多症（erythrocytosis）不良反應的風險可能增加，以避免未來相關心血管風險，另外，須檢測促黃體生成素（LH），排除腦下垂體疾病的可能。

治療前須排除相關的禁忌症如前列腺癌和乳腺癌、紅血球增多症等，有懷孕計畫的男性也不建議進行睪固酮補充治療。

睪固酮補充的治療目標是改善睪固酮濃度不足帶來的各種症狀與不適，並且隨著定期監測提升血中睪固酮濃度，到正常生理所需濃度。根據2017年的系統性文獻回顧資料5，針對男性睪固酮補充治療，收納87篇隨機對照試驗（RCT）及51篇非隨機研究（NRS），睪固酮補充治療改善了生活品質（SMD -0.26，95% CI -0.41 to -0.11）、性慾（SMD 0.33, 95% CI 0.16 to 0.50）、憂鬱（SMD -0.23, 95% CI -0.44 to -0.01）、勃起功能（SMD 0.25, 95% CI 0.10 to 0.41），另外根據2020年的文獻回顧6，睪固酮補充治療對於性功能、貧血、骨骼密度有顯著改善，而活力及身體功能也有所改善，於認知試驗中沒有益處，而在心血管試驗有負面影響。

但在另一篇系統性文獻指出，正確使用睪固酮補充治療並不會使心血管疾病的風險上升。

國際老年男性研究學會（ISSAM）於2015年的建議指出，接受睪固酮補充治療的患者，約3-6周左右能感受到性慾及精神的改善，而全身性的改善約需要持續治療半年至一年以上。

對於已經開始睪固酮補充治療的患者，治療指引皆建議在治療開始後對患者進行持續監測，以評估患者是否對治療有反應及是否遵守療程。在長期接受睪固酮補充療法的病患，通常於治療開始時的3、6、12個月進行睪固酮濃度檢查，此後每隔12個月檢查一次，亦必須定期檢查血紅蛋白（Hgb）、血球容積比（HCT）、抽血檢驗攝護腺特異抗原指數（PSA）、肝功能、血脂和骨密度等參數值的變化，並且定期追蹤前列腺癌、良性攝護腺肥大、紅血球增多症、心血管疾病等潛在風險。

Generally, after the age of 40 or 50, the male hormone function gradually declines, especially the secretion of testosterone.


Lack of "sex", entering "male menopause"


Mr. Wu, 62 years old, is married and is the person in charge of the enterprise. Complained that in the past four years, several "symptoms" had occurred every year. Because of work, he must often go abroad for business negotiations. After returning to the country for the first time four years ago, due to poor jet lag adjustment, he began to experience insomnia. After seeking medical treatment, he took sleeping and sedative drugs according to the doctor's instructions. Over the past few years, I have gradually developed dependence and tolerance to the drug, and the original dose has been unable to improve the symptoms of insomnia.


He often feels feverish and swollen discomfort from the base of his ears, face to neck after dinner, coupled with severe insomnia, anxiety, irritability, impatience, and easy temper tantrums. In the past, it was still possible to be "sexually" vigorous, but in recent years, it has been unable to arouse energy or even feel weak.


After examination, it was found that Mr. Wu's overall testosterone and free testosterone were low, estrogen (LH) and follicle-stimulating hormone (FSH) were elevated, and prolactin and prostate-specific antigen (PSA) were normal. In addition, according to the medical history and screening of the male aging symptom scale, there are sexual dysfunction and obvious physical and mental symptoms. According to the identification standard of ISSM (International Society for the Study of Andrological Aging Medicine), it is presumed that Mr. Wu has entered "male menopause".


Generally, after the age of 40 or 50, the male hormone function gradually declines, especially the secretion of testosterone. The physical and mental discomfort caused by changes in the secretion of hormones in the body is called "male menopause". Since there is no signal of "menopause" in men, it is difficult to determine its occurrence and process clinically. Generally, male menopause occurs ten years later than females. Menopause is different for everyone: Some people experience a hormonal drop without obvious symptoms; others experience annoying menopausal distress but still maintain normal androgen secretion. About 30% of men aged 40-70 will experience clinical symptoms of menopause: emotional instability, depression, depression, hot flashes, palpitations, night sweats, decreased libido, sexual dysfunction, lack of vitality, fatigue, insomnia, memory and concentration Decrease, increase in upper body fat, muscle relaxation, decrease in tension, etc.


testosterone replacement therapy


Testosterone is vital to a man's health. Testosterone is a male hormone that has important effects on the male reproductive system, sexual function, mental state, muscle mass, and bone health.


Testosterone Supplement Capsules are a common oral supplement designed to boost testosterone levels in men. They usually contain natural or synthetic testosterone analogs that enter the bloodstream directly to increase the body's testosterone levels.


Supplementing with testosterone can help men increase libido, improve sexual function, increase muscle mass, lose fat, and enhance bone health, among other things. For menopausal patients, testosterone supplementation can not only reduce waist circumference and improve male sexual function, but also improve three-high control, bone density, memory and depression symptoms.


Hormone Therapy Medications (Androgen Supplements) Cernos Testosterone Capsules


According to the treatment guidelines in Europe and the United States, it is recommended that patients meet the following two conditions:


1. Symptoms and diagnosis related to low testosterone;


2. If the blood testosterone value is lower than normal, it should be evaluated and confirmed by the attending physician before treatment. The American Urological Association (AUA) recommends that before offering testosterone replacement therapy, clinicians should measure hemoglobin concentration and hematocrit (HCT) and inform patients of the possible increased risk of adverse effects of erythrocytosis to avoid future related complications. Cardiovascular risk. In addition, luteinizing hormone (LH) must be tested to rule out the possibility of pituitary gland disease.


Relevant contraindications such as prostate cancer, breast cancer, polycythemia, etc. must be excluded before treatment, and testosterone supplementation therapy is not recommended for men who plan to become pregnant.


The therapeutic goal of testosterone supplementation is to improve various symptoms and discomforts caused by insufficient testosterone concentration, and to increase the blood testosterone concentration to the normal physiologically required concentration along with regular monitoring. According to the systematic literature review data in 2017, 87 randomized controlled trials (RCT) and 51 non-randomized studies (NRS) were included for testosterone supplementation therapy in men, and testosterone supplementation therapy improved the quality of life (SMD -0.26, 95% CI -0.41 to -0.11), libido (SMD 0.33, 95% CI 0.16 to 0.50), depression (SMD -0.23, 95% CI -0.44 to -0.01), erectile function (SMD 0.25, 95% CI 0.10 to 0.41) , In addition, according to a 2020 literature review6, testosterone supplementation therapy significantly improved sexual function, anemia, and bone density, while vitality and physical function also improved. There was no benefit in cognitive tests, but negative effects in cardiovascular tests.


However, another systematic literature pointed out that the correct use of testosterone supplementation therapy does not increase the risk of cardiovascular disease.


The International Society for the Study of Aging Males (ISSAM) suggested in 2015 that patients who receive testosterone supplementation therapy can experience improvements in libido and spirit in about 3-6 weeks, while systemic improvements require continuous treatment for about half a year to a year above.


For patients who have started testosterone replacement therapy, treatment guidelines recommend continuous monitoring of the patient after the start of treatment to assess whether the patient responds to the treatment and adheres to the course of treatment. For patients receiving long-term testosterone replacement therapy, testosterone concentration is usually checked at 3, 6, and 12 months at the beginning of treatment, and then checked every 12 months. Regular checks of hemoglobin (Hgb) and hematocrit ( HCT), blood test for prostate specific antigen index (PSA), liver function, blood lipid and bone density and other parameters, and regularly track potential prostate cancer, benign prostatic hypertrophy, polycythemia, cardiovascular disease and other potential risk.