生物与医学2018jamanetwork.com
睾酮治疗与男性抑郁症状的缓解
Testosterone Treatment and Alleviation of Depressive Symptoms in Men
进阶 · 约 45 分钟读完前置知识：临床试验设计与基础统计、内分泌学基础（睾酮与下丘脑-垂体-性腺轴）、抑郁症状评估量表（如 HAM-D）
导读
这项发表在 JAMA Psychiatry 上的研究考察睾酮治疗能否缓解男性的抑郁症状，属于针对低睾酮男性的临床干预研究。评论区的讨论主要围绕实际使用睾酮替代疗法（TRT）的剂量、给药频率与情绪效果展开，而非论文方法本身。
HN 关注点：睾酮补充是否真能改善情绪，以及现实中医生对激素治疗普遍缺乏经验、剂量与给药频率常被弄错。
后来怎么样
该研究此后常被综述与荟萃分析引用，作为睾酮改善男性情绪症状的证据之一；但睾酮替代疗法始终未进入抑郁症治疗指南，临床上仍不作为抗抑郁手段使用。
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这几条评论里：支持 1 补充 2 亲历 1
亲历亲历者：TRT 更像抗焦虑而非抗抑郁，剂量与给药频率、雌二醇水平是关键，很多医生并不懂激素。
我因脑垂体肿瘤切除受损，已经用了好几年 TRT。我和医生一起调整过剂量，确实发现它对情绪有影响（到一定程度）。从个人经验看，我不确定该称它为抗抑郁药，但在合适剂量下它似乎能压住焦虑。有人说它是"自信药"，但我觉得它更像抗焦虑药。工作糟糕、睡眠不足的一周，我把剂量稍微调高就平静下来——前提是剂量别高到让雌二醇（e2）水平失衡。剂量和用药时长极其重要，弄错任何一个都会让人情绪化、焦虑。现在很多医生对激素非常不专业：我知道有人被开成两周一次甚至一月一次的注射。我换了四个医生才找到现在这位懂行的专家。test-c 半衰期约 6 天，至少应每周给药，理想是每周两次，剂量应让你落在 600–1000 ng/dl。还要密切监测与睾酮密切相关的激素如 e2，如果转化过多，情绪会更糟。有些人还会出现红细胞压积升高，使血液变稠……
throwawaytrt查看英文原文
(throw away because some employers know my actual) I have been on TRT for several years as a result of a damaged pituitary from a tumor that was removed. I have played with the dosages alongside my doctor, and definitely found that (to a certain extent) it really has an effect on my mood. From personal experience, I don't know if it would call it an anti-depressent, but it seems to stifle anxiety at the right doses. Some people say it's a "confidence drug" but my opinion is it performs more like an anti-anxiety drug. I can have a terrible week of work with little sleep, bump my dose a bit and I calm down - as long as the dose is not high enough to put my estrogen (e2) levels out of whack. Dosage and duration are extremely important. If you mess either up it can make you moody and full of anxiety. Many doctors today are incredibly unskilled and uneducated regarding hormones. I know many doctors perscribe trt in one shot per two weeks, and even one shot per month. I had to go through four doctors to find my current who is a specialist and very well educated. With a half life of about 6 days, test-c should be administered at MINIMUM weekly. Ideally bi-weekly. Dosage should be enough to get you in the 600-1000ng/dl range. You also need to carefully observe the hormones that coorelate closely with testosterone, like e2. If that goes to high (aka high converter) your mood will be worse. Some people will also see a rise in hematocrit which thickens the blood and can be a risk factor for a number of things. I do not have this issue as my hematocrit is very stable on or off trt. My blood pressure has actually dropped on TRT. If you can do the balancing act it is overall very good. -- Feel free to ask me anything about TRT and it's effects on mood, hormones, etc. I will try to answer. I have been researching it for years.
支持生活方式（高强度运动、饮食、独处）对睾酮与自我感受的影响与论文结论一致。
我监测游离睾酮的个人经验与此吻合，虽然我从没接受过治疗。比如只有当我在规律打拳（高强度无氧+有氧）、独处和待在户外、坚持高脂低碳饮食、偶尔翘掉工作去做别的事时，我才感觉像自己。我的理解是男性对睾酮反应良好；有很多提升睾酮的活动和食物可能有帮助，必要时也可短期治疗。很高兴这终于得到重视。
jvanderbot查看英文原文
My personal experience with monitoring free testosterone matches this. Though I've never undergone treatments. For example, I only feel like myself when I'm regularly boxing (competitive, high volume anaerobic+aerobic, physically intense), spending time alone and outside, adhering to a higher fat diet/lower carb diet, occasionally blowing off work to do something else, and so on. What I take from this is that men respond well to testosterone. There are a number of testosterone boosting activities and foods that might help, including acute treatment when necessary. Glad this is getting recognition.
补充提醒 TRT 会损害生育力，某些情况下可改用克罗米芬，并附上免责声明。
TRT 的另一个缺点是它会通过抑制睾丸内睾酮大幅降低男性生育能力。通常停药可逆，但少数情况下可能永久。不过视低睾酮的成因（请咨询医生），克罗米芬（clomid）可以促使睾丸自行产生睾酮，甚至达到正常范围上限。所以如果你低睾酮且近两年可能要孩子，可以了解一下。我不是医生，但按本科生物学水平推测，对于外源雌激素暴露等原因导致的低睾酮，clomid 应该很有效。
User23查看英文原文
Another downside of TRT is that it greatly reduces male fertility by suppressing intratesticular testosterone. This is usually reversible by discontinuing treatment, but in rare cases it can be permanent. However depending on the cause of low testosterone (talk to your doctor), clomiphene citrate (clomid) can spur the testes to produce additional testosterone all the way up to the high normal range. So if you have low T and might want children in the next couple years, then look into that. I'm not a doctor, but from my basic undergraduate level understanding of biology I would expect clomid to be highly effective in cases where low testosterone is due to xenoestrogen exposure, among others.
补充贴出绕过付费墙的全文链接，方便读者读原文。
论文全文的 Sci-Hub 链接：https://sci-hub.tw/https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2712976
yasp查看英文原文
https://sci-hub.tw/https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2712976
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