Post Date December, 03 2023
Endocrine impotence is the most common cause of male impotence among all impotence patients. It mainly includes two reasons: hypogonadism and hyperprolactinemia, and their incidence is roughly the same. The diagnosis of endocrine impotence is simple and reliable, the pathogenesis is clear, the treatment is reasonable, and the cure rate is high. The following two types of endocrine impotence will be discussed separately.
The hypogonadism of testosterone is necessary to maintain the sexual desire, secondary sexual characteristics and erectile ability of men. Therefore, when the level of testosterone is low, the patient will have changes in body shape and secondary sexual characteristics or female (female food) appearance, testicular volume will decrease (less than 4 cm in length), sexual desire will be low or lack, and erectile ability will be reduced or disappear. Abnormality of any link of the hypothalamus-pituitary-gonadal axis can lead to a decrease in testosterone level or hypogonadism, and some impotence can occur: including primary testicular disease -- the testosterone level will be significantly reduced to 25.0-250.0ng/d1 (normal value 260.0-1250.0ng/d1), while the gonadotropin level will be significantly increased, such as LH up to 20.0-60.0IU/L (normal value 4.0-12.0IU/L), FSH up to 15.0-60.0IU/L (normal value 5.5-9.0IU/L), Secondary hypogonadism is caused by hypogonadism of gonadotropin level caused by hypothalamic or pituitary dysfunction, such as LH is 0.2-3.5IU/L, FSH is 1.0-5.0IU/L. In the case of alcoholism, extreme obesity or thyroid dysfunction, the level of free testosterone should be measured, because the low level of total testosterone may be related to the low level of testosterone binding protein, rather than the real endocrine disorder. In addition to the total testosterone level, the determination of testosterone also includes the levels of free testosterone and bioavailable testosterone, and the bioavailable testosterone includes free and albumin-bound testosterone (in the past, only free testosterone was considered to have biological activity). The bioavailable testosterone is easier to measure than free testosterone, as long as the testosterone binding globulin is precipitated with ammonium sulfate. Primary hypogonadism includes Klinefelter's syndrome (congenital seminiferous tubule hypoplasia, chromosome 47, XXY), bilateral cryptorchidism, orchitis, testicular injury, etc; Secondary hypogonadism includes Kalman's syndrome (hypothalamic disease) and pituitary tumor. In addition, there are also elderly (elderly food) people with low blood testosterone.
The patients with hypogonadism treated with impotence are often accompanied by low libido. Its beard and body hair disappear within half a year to one year. It should be suspected that it is complicated with adrenal cortical lesions, such as Addison's disease.
For impotence patients with hypogonadism, the purpose of androgen replacement therapy is to maintain normal serum testosterone level, enhance sexual desire, restore sexual function and promote the development of secondary sexual signs. At present, the commonly used oral androgen is absorbed by the intestinal lymphatic system and directly enters the blood through the thoracic duct. Because of avoiding the metabolism of the liver, the serum testosterone can be raised to the treatment level; The long-acting preparation of testosterone undecanoate for injection is injected once a month, 250 mg each time, and the course of treatment is 4 months.
Patients with secondary hypogonadism can also be treated with gonadotropin drugs, such as human chorionic gonadotropin or human menopausal gonadotropin. During testosterone replacement therapy, attention should be paid to the side effects of drugs, such as the aromatization of testosterone into estradiol in the body, and the change of the ratio of serum testosterone to estradiol can cause breast tenderness or male (male food) breast feminization; Exogenous testosterone can inhibit the release of gonadotropin and testicular spermatogenesis. It should be used with caution in patients with secondary hypogonadism who are not fertile. During treatment, liver function and red blood cells should be tested regularly.
