男性性激素測定從保列治的應(yīng)用開始看山是山，看水是水看山不是山，看水不是水CompanyLogo+DHTCompanyLogoCompanyLogoCompanyLogo5-ARIsCompanyLogo5-ARIsserumDHT70%withfinasteride.95%stateDHTconcentrationisreducedtoasimilarlevel(85-90%)byboth5-ARIs.

CompanyLogo5-ARIsimproveIPSS15-30%,Qmax↑1.5-2.0mL/s

CompanyLogo5-ARIsEDCompanyLogo5-ARIsContributestohighGleasongradePCa

CompanyLogo5-ARIsserumT↑23%-24%duringthe4-yearstudyperiodPlacebowithaslightincreaseof1%to6%inthe

CompanyLogo前列腺內(nèi)CompanyLogo性功能CompanyLogoDHT＞TCompanyLogopotentialnegative

cardiovascularevents,anddepression

CompanyLogoMoralesaWangC,etal.Investigation,treatment,andmonitoringoflate-onsethypogonadisminmales:ISA,ISSAM,EAU,EAAandASARecommendations.EurUrol2009;55:121-130遲發(fā)性性腺功能減退癥定義遲發(fā)性性腺功能減退癥（Late-onsethypogonadism,LOH）：一種與年齡增長相關(guān)的臨床和生物化學(xué)綜合征。其特征為：具有一定臨床癥狀；血清睪酮水平降低；對機(jī)體多種器官、系統(tǒng)功能有不利影響；嚴(yán)重影響生活質(zhì)量。ShalenderBhasin,.TestosteroneTherapyinMenwithAndrogenDeficiencySyndromes:AnEndocrineSocietyClinicalPracticeGuideline.JClinEndocrinolMetab95:2536–2559,2010雄激素缺乏的常見癥狀/體征特異性較高的癥狀/體征特異性較低癥狀/體征性發(fā)育遲緩或不全乏力、精力減退、缺少自信性欲減退抑郁勃起功能障礙注意力以及記憶力下降不育睡眠障礙小睪丸（<5ml）輕度貧血毛發(fā)減少肌肉容量及肌力下降乳腺不適，男子女性型乳房脂肪增多骨質(zhì)疏松體重指數(shù)增加面色潮紅、多汗體格下降及工作效率下降LOH各國指南及診斷標(biāo)準(zhǔn)指南發(fā)表時間LOH診斷標(biāo)準(zhǔn)男性遲發(fā)性性腺功能減退癥的觀察、治療和檢測2008癥狀、體征TT<8nmol/L如TT在8-12nmol/L之間，則需重新測定或計算FT，F(xiàn)T<225pmol/L男性性腺功能減退癥診療手冊2009用AMS或ADAM量表評估癥狀根據(jù)出現(xiàn)癥狀提示，結(jié)合TT<11.5nmol/L成年男性睪酮缺乏綜合征的睪酮治療2010癥狀、體征TT<8nmol/L如TT在8-12nmol/L之間，則需重新測定或計算FT，F(xiàn)T<225pg/mL男性遲發(fā)性性腺功能減退癥指南2012癥狀、體征TT<8nmol/L如TT在8-11nmol/L之間，F(xiàn)T<220pg/mL男科學(xué)-睪酮治療2012癥狀、體征TT<8nmol/L如TT在8-12nmol/L之間，F(xiàn)T<225pg/mL游離睪酮與白蛋白結(jié)合的睪酮與性激素結(jié)合球蛋白結(jié)合的睪酮2%30-40%50-60%生物活性睪酮無生物活性睪酮總睪酮正常值：12-35nmol/L睪酮的存在形式CompanyLogoTlutsstudieshavedemonstratedthattheprostatecanincreasein

volumebyapproximately

withtheadditionoftestosterone,

whichisthoughtmaybeenoughtodecompensateasignifiantly

obstructedbladder

CompanyLogoThEuropeanAssociationofUrologyguidelineswarn

thatandrogendeprivationtherapy

(ADT)iscontraindicatedinmenwithsevereLUTS(IPSS

>

21).

CompanyLogo激素的測定血液中甾體激素的測定可采用光譜分析法(包括紫外分光光度法和熒光分析法)色譜法（包括高效液相色譜分析法、氣相色譜與質(zhì)譜聯(lián)用分析法、膠束電動毛細(xì)管色譜法）、免疫學(xué)分析方法（包括放射免疫測定法、化學(xué)發(fā)光免疫測定法）磁分離酶聯(lián)免疫測定法。CompanyLogoFT測定在純度和溫度嚴(yán)格控制下

平衡透析法測定是生理學(xué)上評估血清FT最經(jīng)典的方法

CompanyLogoVermeulen公式計算www.issam.chFT或Bio-T計算器CompanyLogowww.issam.ch游離睪酮或生物活性睪酮計算器游離睪酮或生物活性睪酮檢測方法平衡透析法過于復(fù)雜臨床推廣難類同方法不準(zhǔn)確故不推薦32Bio-T測定硫酸銨鹽沉淀SHBG-T，再測定Bio-T從而評估FTCompanyLogo酶免法酶免法測得FT僅占0.23%相差8-9倍CompanyLogoSummery設(shè)想，評估一男性的激素情況應(yīng)該多維度（T、DHT、DHEA等）

細(xì)分解（TT、FT、Bio-T等）？CompanyLogoman’sLUTS

isappropriatelytreatedthereisnolongeracontraindicationtoTRT

CompanyLogoHowever,about25%–30%ofpatientsdonotexperienceanyimprovementintheir

urinarysymptomsandanother5%–7%developedworseningsymptomsandmayultimatelyrequiresurgery[8].Itshouldbenotedthatresistancetotherapywithfinasteride

mayoccurthroughsilencingofthe5α-Rtype2genebyDNA

methylation,leadingtoastateinwhichapproximately30%ofpatientsdonotexpress5α-Rtype2intheprostateCompanyLogoTableLUTS睪酮T5α-RsCompanyLogoHigherlevelsofserumfreetestosteroneareassociatedwithanincreasedriskof

aggressiveprostatecanceramongoldermen.

CompanyLogo5-ARIsThis

mayexplainsomeofthenotedsymptomssuchasanxiety,

depressionandsuicideinpatientswhohavebeentreated

withfinasteride

CompanyLogo5α-Rswas23%[95%confidenceinterval11.1%to

35.6%],25%[95%confidenceinterva