男性性欲与血清生殖激素水平相关性分析
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摘要
目的:探讨男性性欲与血清生殖激素水平的相关性。方法:收集郑州大学第一附属医院男科门诊134例患者临床资料,以13项目男子性欲自评量表为标准,将研究对象分成性欲低下组和性欲正常组,所有患者均排除有甲状腺及肾上腺疾病,肝肾疾病且停用各种影响性功能及生殖激素的药物2周以上,统计两组的年龄、病史及病程,检测两组患者的血清T、E2、LH、FSH及PRL水平,并计算T/E2。并进一步分析性欲与生殖激素的相关性结果:性欲低下组病程显著长于性欲正常组[(2.91±0.08)年vs(1.83±0.44)年,P<0.05],两组性欲评分[(19.56±0.89)分vs(31.47±1.28)分,P<0.01]、T[(11.46±1.62) nmol/L vs(17.51±3.68) nmol/L,P<0.01]、T/E2(12.42±1.38 vs 17.27±3.94,P<0.01)差异均有统计学意义,而年龄[(31.98±2.19)岁vs(32.22±2.29)岁]、E2 [(94.45±10.37) pmol/L vs(114.38±14.72) pmol/L]、FSH[(7.43±3.84) IU/L vs(9.98±5.26)IU/L]、LH[(5.20±3.37)I U/L vs(5.70±3.17) IU/L]、PRL [(371.85±243.38) mIU/L vs(281.96±82.68) IU/L]差异均无统计学意义。相关性分析显示,两组性欲评分与T(r=0.535、0.329)、T/E2(r=0.603、0.542)呈正相关(P均<0.01);T与E2(r=0.644、0.743)、T/E2(r=0.618、0.387)也具有相关性(P均<0.01)。T、E2、T/E2三者ROC曲线下面积分别为:0.660、0.527、0.669,当T/E2为12.15～15.73时,诊断性欲低下的灵敏度和特异度相对较高(均>0.5)。结论:①T、T/E2均是男性性欲的重要影响因素,E2也可能是男性性欲的影响因素之一;②男性性欲和T/E2的相关性更好,T/E2为12.15～15.73时,提示性欲可能正常,若打破这个平衡,无论高或低都可能出现性欲低下。
Objective: To investigate the correlation between male libido and the levels of serum reproductive hormones. Methods: We collected the clinical data on 134 men complaining of low or decreased sexual desire at our clinic of andrology from January 2013 to July 2018. According to the scores on the 13-item Self-Rating Libido Scale for Males(SRLS-M), we divided the subjects into a low libido(n = 68) and a normal libido group(n = 66), none with thyroid and adrenal diseases, liver and kidney diseases, or administration of drugs affecting sexual function and reproductive hormones in the past two weeks. We compared the age, history and course of disease, SRLS-M scores, levels of serum T, E2, LH, FSH and PRL, and T/E2 ratio between the two groups, and analyzed the correlation of the parameters obtained with the SRLS-M scores of the patients by Pearson correlation analysis. Results: Compared with the males of the normal libido group, the low-libido patients showed a significantly longer course of disease([1.83 ± 0.44] vs [2.91 ± 0.08] yr, P < 0.05), but lower SRLS-M score(31.47 ± 1.28 vs 19.56 ± 0.89, P < 0.01), T level([17.51 ± 3.68] vs [11.46 ± 1.62] nmol/L, P < 0.01) and T/E2 ratio(17.27 ± 3.94 vs 12.42 ± 1.38, P < 0.01). No statistically significant differences were found between the normal and low libido groups in age([32.22 ± 2.29] vs [31.98 ± 2.19] yr) or the levels of E2([103.97 ± 15.70] vs [94.45 ± 10.37] pmol/L), FSH([9.98 ± 5.26] vs [7.43 ± 3.84] IU/L), LH([5.70 ± 3.17] vs [5.20 ± 3.37] IU/L), or PRL([281.96 ± 82.68] vs [371.85 ± 243.38] mIU/L). Pearson correlation analysis showed that the SRLS-M scores of the patients in the normal and low libido groups were positively correlated with the T level(r = 0.329 and 0.535, P<0.01) and T/E2 ratio(r = 0.542 and 0.603, P<0.01), and so was the T level with E2(r = 0.743 and 0.644, P<0.01) and T/E2(r = 0.387 and 0.618, P<0.01). The areas under the ROC curves for T, E2 and T/E2 were 0.660, 0.527 and 0.669, respectively. A T/E2 ratio of 12.15-15.73 exhibited a relatively high sensitivity(>0.5) and specificity(>0.5) in the diagnosis of low libido. Conclusion: The T level and T/E2 ratio are important factors, and E2 may also be a factor, influencing male libido, which, however, is more correlated with T/E2. A T/E2 ratio of 12.15-15.73 may be an indicator of normal libido, while a lower or higher T/E2 ratio may suggests low libido. Natl J Androl, 2019, 25(6): 509-513
Objective: To investigate the correlation between male libido and the levels of serum reproductive hormones. Methods: We collected the clinical data on 134 men complaining of low or decreased sexual desire at our clinic of andrology from January 2013 to July 2018. According to the scores on the 13-item Self-Rating Libido Scale for Males(SRLS-M), we divided the subjects into a low libido(n = 68) and a normal libido group(n = 66), none with thyroid and adrenal diseases, liver and kidney diseases, or administration of drugs affecting sexual function and reproductive hormones in the past two weeks. We compared the age, history and course of disease, SRLS-M scores, levels of serum T, E2, LH, FSH and PRL, and T/E2 ratio between the two groups, and analyzed the correlation of the parameters obtained with the SRLS-M scores of the patients by Pearson correlation analysis. Results: Compared with the males of the normal libido group, the low-libido patients showed a significantly longer course of disease([1.83 ± 0.44] vs [2.91 ± 0.08] yr, P < 0.05), but lower SRLS-M score(31.47 ± 1.28 vs 19.56 ± 0.89, P < 0.01), T level([17.51 ± 3.68] vs [11.46 ± 1.62] nmol/L, P < 0.01) and T/E2 ratio(17.27 ± 3.94 vs 12.42 ± 1.38, P < 0.01). No statistically significant differences were found between the normal and low libido groups in age([32.22 ± 2.29] vs [31.98 ± 2.19] yr) or the levels of E2([103.97 ± 15.70] vs [94.45 ± 10.37] pmol/L), FSH([9.98 ± 5.26] vs [7.43 ± 3.84] IU/L), LH([5.70 ± 3.17] vs [5.20 ± 3.37] IU/L), or PRL([281.96 ± 82.68] vs [371.85 ± 243.38] mIU/L). Pearson correlation analysis showed that the SRLS-M scores of the patients in the normal and low libido groups were positively correlated with the T level(r = 0.329 and 0.535, P<0.01) and T/E2 ratio(r = 0.542 and 0.603, P<0.01), and so was the T level with E2(r = 0.743 and 0.644, P<0.01) and T/E2(r = 0.387 and 0.618, P<0.01). The areas under the ROC curves for T, E2 and T/E2 were 0.660, 0.527 and 0.669, respectively. A T/E2 ratio of 12.15-15.73 exhibited a relatively high sensitivity(>0.5) and specificity(>0.5) in the diagnosis of low libido. Conclusion: The T level and T/E2 ratio are important factors, and E2 may also be a factor, influencing male libido, which, however, is more correlated with T/E2. A T/E2 ratio of 12.15-15.73 may be an indicator of normal libido, while a lower or higher T/E2 ratio may suggests low libido. Natl J Androl, 2019, 25(6): 509-513
引文
[1] 中华医学会精神科分会,南京医科大学脑科医院编.中国精神疾病分类方案与诊断标准.南京:东南大学出版社,1995.97.
[2] 齐涛,张滨,金铭昱,等.男性自评性欲量表的编制.中国性科学,2011,20(12):8-12
[3] 徐建峰.48例中青年男性性欲低下患者的病医学及中医症候学研究(硕士论文).北京:北京中医药大学,2013.
[4] Meuleman EJ,van Lankveld JJ.Hypoactive sexual desire disorder:An underestimated condition in men.BJU Int,2015,95(3):291-296.
[5] 阮芳斌著.新性知识手册.昆明:云南人民出版社,2013.119-124.
[6] Finch PM,Price LM,Pullan PT,et al.Effects of testosterone treatment on bone mineral density in hypogonadal men receiving intrathecal opioids.Pain Practice,2015,15(4):308-313.
[7] Traish AM .Testosterone therapy in men with testosterone deficiency:Are the benefits and cardiovascular risks real or imagined?Am J Physiol Regul Integr Comp Physiol,2016,311(3):566-567.
[8] Kelly DM,Jones TH.Testosterone:A vascular hormone in health and disease.J Endocrinol,2013,217(3):R47-R71.
[9] Kelly DM,Jones TH.Testosterone:A metabolic hormone in health and disease.J Endocrinol,2013,217(3):25-45.
[10] Traish A.Testosterone therapy in men with testosterone deficiency:Are we beyond the point of no return?Invest Clin Urol,2016,57(6):384-400.
[11] Rastrelli G,Corona G,Maggi M.Testosterone and sexual function in men.Maturitas,2018,112:46-52.
[12] Corona G,Rastrelli G,Morgentaler A,et al.Meta-analysis of results of testosterone therapy on sexual function based on International Index of Erectile Function Scores.Eur Urol,2017,72(6):1012-1013.
[13] Traish A.Testosterone therapy in men with testosterone deficiency:Are we beyond the point of no return?Investigat Clin Urol,2016,57(6):384-400.
[14] Corona G,Isidori AM,Buvat J,et al.Testosterone supplementation and sexual function:A meta-analysis study.J Sex Med,2014,11(6):1577-1592.
[15] Hackett G,Cole N,Saghir A,et al.Testosterone undecanoate improves sexual function in men with type 2 diabetes and severe hypogonadism:Results from a 30-week randomized placebo-controlled study.BJU Int,2016,118(5):804-813.
[16] Heidelbaugh JJ.Endocrinology update:Testicular hypogonadism.FP Essent,2016,451:31-41.
[17] Castelló-Porcar AM,Martínez-Jabaloyas JM.Testosterone/estradiol ratio,is it useful in the diagnosis of erectile dysfunction and low sexual desire?Aging Male,2016,19(4):254-258.
[18] Corona G,Petrone L,Mannucci E,et al.The impotent couple:Low desire.Int J Androl,2005,28(Suppl2):46-52.
[19] 王宏,马国珍,李卓朝.冬泳对老年男性性激素与性欲的影响.中国性科学,2005,14(10):6-7.
[20] Takahiro M,Shin-Ichiro H,Nobuhiro H.Alteration in sex-specific behaviors in male mice lacking the aromatase gene.Neuroendocrinology,2003,77(6):416-424.
[21] Schellhammer PF.Gonadal steroids and body composition,strength,and sexual function in men.N Engl J Med,2013,369(11):1011-1022.
[2] 齐涛,张滨,金铭昱,等.男性自评性欲量表的编制.中国性科学,2011,20(12):8-12
[3] 徐建峰.48例中青年男性性欲低下患者的病医学及中医症候学研究(硕士论文).北京:北京中医药大学,2013.
[4] Meuleman EJ,van Lankveld JJ.Hypoactive sexual desire disorder:An underestimated condition in men.BJU Int,2015,95(3):291-296.
[5] 阮芳斌著.新性知识手册.昆明:云南人民出版社,2013.119-124.
[6] Finch PM,Price LM,Pullan PT,et al.Effects of testosterone treatment on bone mineral density in hypogonadal men receiving intrathecal opioids.Pain Practice,2015,15(4):308-313.
[7] Traish AM .Testosterone therapy in men with testosterone deficiency:Are the benefits and cardiovascular risks real or imagined?Am J Physiol Regul Integr Comp Physiol,2016,311(3):566-567.
[8] Kelly DM,Jones TH.Testosterone:A vascular hormone in health and disease.J Endocrinol,2013,217(3):R47-R71.
[9] Kelly DM,Jones TH.Testosterone:A metabolic hormone in health and disease.J Endocrinol,2013,217(3):25-45.
[10] Traish A.Testosterone therapy in men with testosterone deficiency:Are we beyond the point of no return?Invest Clin Urol,2016,57(6):384-400.
[11] Rastrelli G,Corona G,Maggi M.Testosterone and sexual function in men.Maturitas,2018,112:46-52.
[12] Corona G,Rastrelli G,Morgentaler A,et al.Meta-analysis of results of testosterone therapy on sexual function based on International Index of Erectile Function Scores.Eur Urol,2017,72(6):1012-1013.
[13] Traish A.Testosterone therapy in men with testosterone deficiency:Are we beyond the point of no return?Investigat Clin Urol,2016,57(6):384-400.
[14] Corona G,Isidori AM,Buvat J,et al.Testosterone supplementation and sexual function:A meta-analysis study.J Sex Med,2014,11(6):1577-1592.
[15] Hackett G,Cole N,Saghir A,et al.Testosterone undecanoate improves sexual function in men with type 2 diabetes and severe hypogonadism:Results from a 30-week randomized placebo-controlled study.BJU Int,2016,118(5):804-813.
[16] Heidelbaugh JJ.Endocrinology update:Testicular hypogonadism.FP Essent,2016,451:31-41.
[17] Castelló-Porcar AM,Martínez-Jabaloyas JM.Testosterone/estradiol ratio,is it useful in the diagnosis of erectile dysfunction and low sexual desire?Aging Male,2016,19(4):254-258.
[18] Corona G,Petrone L,Mannucci E,et al.The impotent couple:Low desire.Int J Androl,2005,28(Suppl2):46-52.
[19] 王宏,马国珍,李卓朝.冬泳对老年男性性激素与性欲的影响.中国性科学,2005,14(10):6-7.
[20] Takahiro M,Shin-Ichiro H,Nobuhiro H.Alteration in sex-specific behaviors in male mice lacking the aromatase gene.Neuroendocrinology,2003,77(6):416-424.
[21] Schellhammer PF.Gonadal steroids and body composition,strength,and sexual function in men.N Engl J Med,2013,369(11):1011-1022.