Human Chorionic Gonadotropin monotherapy for the treatment of hypogonadal symptoms in men with total testosterone > 300 ng/dL

ABSTRACT Purpose The 2018 American Urological Association guidelines on the Evaluation and Management of Testosterone Deficiency recommended that 300 ng/dL be used as the threshold for prescribing testosterone replacement therapy (TRT). However, it is not uncommon for men to present with signs and symptoms of testosterone deficiency, despite having testosterone levels greater than 300 ng/dL. There exists scant literature regarding the use of hCG monotherapy for the treatment of hypogonadism in men not interested in fertility. We sought to evaluate serum testosterone response and duration of therapy of hCG monotherapy for men with symptoms of hypogonadism, but total testosterone levels > 300 ng/dL. Materials and Methods We performed a multi-institutional retrospective case series of men receiving hCG monotherapy for symptomatic hypogonadism. We evaluated patient age, treatment indication, hCG dosage, past medical history, physical exam findings and serum testosterone and gonadotropins before and after therapy. Descriptive analysis was performed and Mann Whitney U Test was utilized for statistical analysis. Results Of the 20 men included in the study, treatment indications included low libido (45%), lack of energy (50%), and erectile dysfunction (45%). Mean testosterone improved by 49.9% from a baseline of 362 ng/dL (SD 158) to 519.8 ng/dL (SD 265.6), (p=0.006). Median duration of therapy was 8 months (SD 5 months). Fifty percent of patients reported symptom improvement. Conclusions Treatment of hypogonadal symptoms with hCG for men who have a baseline testosterone level > 300 ng/dL appears to be safe and efficacious with no adverse events.

摘要
目的 2018年美国泌尿外科学会（American Urological Association, AUA）发布的《睾酮缺乏症评估与管理指南》建议，将300 ng/dL作为开具睾酮替代疗法（Testosterone Replacement Therapy, TRT）的阈值。然而，部分男性血清总睾酮水平高于300 ng/dL，却仍表现出睾酮缺乏症的体征与症状，此类情况并不少见。目前针对无生育需求男性采用人绒毛膜促性腺激素（human chorionic gonadotropin, hCG）单药治疗性腺功能减退症的相关研究文献较为匮乏。本研究旨在评估对于存在性腺功能减退症症状但血清总睾酮水平＞300 ng/dL的男性，采用hCG单药治疗后的血清睾酮应答情况与治疗持续时长。

材料与方法 本研究开展了一项多中心回顾性病例系列研究，纳入因症状性性腺功能减退症接受hCG单药治疗的男性患者。研究收集并分析了患者的年龄、治疗指征、hCG给药剂量、既往病史、体格检查结果，以及治疗前后的血清睾酮与促性腺激素水平。本研究采用描述性分析方法，并使用曼-惠特尼U检验（Mann Whitney U Test）进行统计学分析。

结果 本研究共纳入20例男性患者，其治疗指征分别为性欲低下（45%）、精力不足（50%）与勃起功能障碍（45%）。患者的平均血清睾酮水平从基线的362 ng/dL（标准差SD=158）提升至519.8 ng/dL（SD=265.6），增幅达49.9%（p=0.006）。患者的治疗中位持续时长为8个月（SD=5个月）。50%的患者自述症状有所改善。

结论 对于基线血清睾酮水平＞300 ng/dL的男性，采用hCG治疗其性腺功能减退症相关症状，似乎安全有效且未出现不良事件。