精神疾患を伴うLOH症候群に対するテストステロン補充療法の検討

Testosterone replacement therapy for late-onset hypogonadism syndrome with mental disorder

　当院の男性更年期外来を受診しテストステロン補充療法を行った全201症例中，治療開始時に精神疾患のため薬物療法を行っていた70例を検討した．背景にある精神疾患に関して6割弱は抑うつ状態，3割は全般性不安障害，1割は統合失調症であった．治療前の患者背景は精神疾患の有無で比較した場合，遊離テストステロン値に差を認めず，精神疾患を有する群は年齢が低く男性更年期症状を評価するAMSスコアが高く症状が強い傾向であった．治療効果に関しては，抗うつ薬や抗不安薬を投与されている症例でも約4割に自覚症状の改善が認められ，治療経過も相違なかった．したがって，前述のような症例でも低テストステロンを認めた場合，積極的な治療介入が選択肢となりうると思われた．

Abstract

A variety of psychological problems will occur in men with late-onset hypogonadism (LOH) syndrome, which is caused by decreased serum testosterone level. However, little is known about the efficacy of testosterone replacement therapy (TRT) for men with LOH syndrome who have mental disorder. We investigated a total of 201 men with LOH syndrome who underwent TRT. Among 201 men, 70 men had mental disorder, such as depression, generalized anxiety disorder, and schizophrenia. It was observed that LOH patients who had mental disorder were more likely to be younger with higher aging male symptoms score, whereas there was no difference in free testosterone level before TRT. Regardless of mental disorder, efficacy and treatment pattern of TRT were not significantly different between groups. Especially, among men who had depression and anxiety disorder, it seems that TRT relieved those psychological symptoms. Therefore, own present results demonstrated that TRT could be a feasible option for men with mental disorder (Rinsho Hinyokika 72 : 1019-1025, 2018).