Organic male hypogonadism due to irreversible hypothalamic–pituitary–testicular (HPT) pathology is easily diagnosed and treated with testosterone-replacement therapy. However, controversy surrounds the global practice of prescribing testosterone to symptomatic men with low testosterone and non-gonadal factors reducing health status, such as obesity, type 2 diabetes, and ageing (ie, functional hypogonadism), but without identifiable HPT axis pathology. Health optimisation remains the gold-standard management strategy. Nevertheless, in the last decade large clinical trials and an individual patient data meta-analysis of smaller clinical trials confirmed that testosterone therapy induces modest, yet statistically significant, improvements in sexual function without increasing short-term to medium-term cardiovascular or prostate cancer risks in men with functional hypogonadism. Although testosterone improves bone mineral density and insulin sensitivity in these men, trials from the last decade suggest insufficient evidence to determine the safety and effectiveness of use of this hormone for the prevention of fractures or type 2 diabetes. This Review discusses the pathogenesis and diagnosis of male hypogonadism and appraises the evidence underpinning the management of this condition.

中文翻译：

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男性性腺功能减退症：发病机制、诊断和治疗


由不可逆的下丘脑-垂体-睾丸（HPT）病理引起的器质性男性性腺功能减退症很容易通过睾酮替代疗法进行诊断和治疗。然而，对于有低睾酮水平和非性腺因素降低健康状况（如肥胖、2 型糖尿病和衰老（即功能性性腺功能减退症））但没有可识别的 HPT 轴病理的男性患者使用睾酮的全球实践存在争议。健康优化仍然是黄金标准管理策略。然而，在过去十年中，大型临床试验和小型临床试验的个体患者数据荟萃分析证实，睾酮治疗可适度改善性功能，但具有统计学意义，且不会增加短期至中期心血管或前列腺癌风险患有功能性性腺功能减退症的男性。尽管睾酮可以改善这些男性的骨矿物质密度和胰岛素敏感性，但过去十年的试验表明，没有足够的证据来确定使用这种激素预防骨折或 2 型糖尿病的安全性和有效性。本综述讨论了男性性腺功能减退症的发病机制和诊断，并评估了支持该病症治疗的证据。