男性更年期障害の重症度分類による男性ホルモン軟膏の治療効果の検討

Abstract

男性更年期障害(LOH)で暫定的指標として定めた値である血中総テストステロン(TT)3.18ng/ml, 遊離型テストステロン(FT)10.0pg/ml未満を示した50名(年齢34～81歳)を対象としたが解析可能は36名であった。調査項目のCut off値を定め, 男性更年期障害の症状スコア(AMS)総得点50点未満の軽/中等症25名と50点以上の重症11名, TT3.18ng/ml以上の高値12名と未満の低値24名, FT7.3pg/ml(YAM値の50%)以上の高値20名と未満の低値16名, FT9.1pg/ml(YAM値の60%)以上の高値7名と低値20名を重症度分類で2分割し比較した。男性ホルモン軟膏使用前後におけるAMS, 国際勃起機能スコア(IIEF5), 健康調査票(SF-36)変化ではAMSの心理ドメイン, SF-36の体の痛み(BP), 社会生活(SF), RE日常的役割においてAMSスコアが高い重症群に, より改善が見られ有意差を認めた。また, TT値の高値群においてSF-36のBPに, より改善が見られたがその他に有意差は認められなかった。

The most basic treatment for late-onset hypogonadism (LOH) is hormone replacment therapy (HRT). In Japan, intra-muscular injection of testosterone (T) has been used for LOH treatment as HRT. Testosterone ointment (Glowmin) has been available for HRT from 1965 as an over-the-counter drug, and the profile of serum T levels and efficacy of testosterone ointment for LOH patients has been reported. In this study, we analyzed the relationship between the efficacy of testosterone ointment and LOH severity. Fifty LOH patients were treated with 6 mg of testosterone ointment per day. After 12 weeks of treatment, they were divided into 2 groups according to the severity of their LOH, serum total T and free T levels, measured by such means as total aging males' symptoms (AMS) score. The improvements of total AMS score, international index of erectile function 5 score and MOS 36-Item Short-Form Health Survey (SF-36) score were observed and analysis of variation was performed. Results showed that the symptoms in the more severe patients had a total AMS score improvement in 4 domains, AMS (psychological), SF-36 body pain (BP), social function (SF), role-emotion, compared to patients with slight LOH. While patients with normal serum T levels felt BP improvement as opposed to patients with low serum T levels, there was no significant difference in the other domains. In conclusion, testosterone ointment is considered to be effective in improving several elements of AMS and SF-36 in patients with a high AMS score.